Healthcare Provider Details

I. General information

NPI: 1619064474
Provider Name (Legal Business Name): CYNTHIA M MCMAHON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WARD LN
NORTH FRANKLIN CT
06254-1016
US

IV. Provider business mailing address

6 WARD LN
NORTH FRANKLIN CT
06254-1016
US

V. Phone/Fax

Practice location:
  • Phone: 860-642-4349
  • Fax: 860-642-6409
Mailing address:
  • Phone: 860-642-4349
  • Fax: 860-642-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7622
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: