Provider Demographics
NPI:1649873373
Name:KLEIN, CYNTHIA L (RPH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:KLEIN
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 1:603 PINECONE CV
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3704
Mailing Address - Country:US
Mailing Address - Phone:251-767-4489
Mailing Address - Fax:
Practice Address - Street 1:60 S HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-3996
Practice Address - Country:US
Practice Address - Phone:850-269-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist