Healthcare Provider Details

I. General information

NPI: 1639512510
Provider Name (Legal Business Name): CYNTHIA SHEPARD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 E SOMERSET DR
CORNVILLE AZ
86325-5192
US

IV. Provider business mailing address

950 FAIR ST
PRESCOTT AZ
86305-1806
US

V. Phone/Fax

Practice location:
  • Phone: 307-320-5883
  • Fax:
Mailing address:
  • Phone: 928-778-6887
  • Fax: 928-776-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2710
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026989
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: