Provider Demographics
NPI:1972627941
Name:SHILAN, CYNTHIA VAUGHAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:VAUGHAN
Last Name:SHILAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REVA
Mailing Address - State:VA
Mailing Address - Zip Code:22735-3548
Mailing Address - Country:US
Mailing Address - Phone:540-270-7460
Mailing Address - Fax:
Practice Address - Street 1:208 E MADISON ST
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:VA
Practice Address - Zip Code:22734-9630
Practice Address - Country:US
Practice Address - Phone:540-439-7327
Practice Address - Fax:540-439-7324
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202006437OtherVA BOARD OF PHARMACY