MEDICARE: MRS. CYNTHIA SMITH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4952700-1701	UT

General Provider Information

NPI Number	:	1700489960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA SMITH PHARMD

Provider Business Mailing Address
First Line	:	1982 W 1700 S
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9698
Country	:	US
Telephone Number	:	801-825-2679
Fax Number	:	801-773-3040

Provider Business Practice Location Address
First Line	:	1982 W 1700 S
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9698
Country	:	US
Telephone Number	:	801-825-2679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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