Provider Demographics
NPI:1245472695
Name:SMALL, CYNTHIA SHARISSE (PHARMDD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:SHARISSE
Last Name:SMALL
Suffix:
Gender:F
Credentials:PHARMDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 NOBLE AVE
Mailing Address - Street 2:APT 2J
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4740
Mailing Address - Country:US
Mailing Address - Phone:203-301-4016
Mailing Address - Fax:
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:215-707-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist