Provider Demographics
NPI:1831191311
Name:DERDEN, CYNTHIA G (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:G
Last Name:DERDEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:CINDIE
Other - Middle Name:G
Other - Last Name:DERDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2990 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3648
Mailing Address - Country:US
Mailing Address - Phone:972-231-2792
Mailing Address - Fax:
Practice Address - Street 1:6850 N SHILOH RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2912
Practice Address - Country:US
Practice Address - Phone:972-496-4403
Practice Address - Fax:972-496-4303
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist