Provider Demographics
NPI:1255610028
Name:STAFFORD, CINDI LEA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CINDI
Middle Name:LEA
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MOUNTAIN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239-8100
Mailing Address - Country:US
Mailing Address - Phone:336-859-5149
Mailing Address - Fax:704-463-5831
Practice Address - Street 1:396 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:NC
Practice Address - Zip Code:28137-5717
Practice Address - Country:US
Practice Address - Phone:704-463-0505
Practice Address - Fax:704-463-5831
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN011628183500000X
NC17479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist