Provider Demographics
NPI:1427434273
Name:KUCELA, CYNTHIA BASS (RPH)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:BASS
Last Name:KUCELA
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 1:100 MYRTLE BLVD
Mailing Address - Street 2:EAST CENTRAL REGIONAL HOSPITAL DEPT OF PHARMACY
Mailing Address - City:GRACEWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30812
Mailing Address - Country:US
Mailing Address - Phone:706-790-2496
Mailing Address - Fax:706-790-2340
Practice Address - Street 1:100 MYRTLE BLVD
Practice Address - Street 2:EAST CENTRAL REGIONAL HOSPITAL DEPT OF PHARMACY
Practice Address - City:GRACEWOOD
Practice Address - State:GA
Practice Address - Zip Code:30812
Practice Address - Country:US
Practice Address - Phone:706-790-2496
Practice Address - Fax:706-790-2340
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist