Provider Demographics
NPI:1336401991
Name:PATE-STUPPNIG, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:PATE-STUPPNIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 DALLAS HIGH SHOALS HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-1306
Mailing Address - Country:US
Mailing Address - Phone:704-922-5257
Mailing Address - Fax:704-922-7749
Practice Address - Street 1:3126 DALLAS HIGH SHOALS HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1306
Practice Address - Country:US
Practice Address - Phone:704-922-5257
Practice Address - Fax:704-922-7749
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist