Healthcare Provider Details

I. General information

NPI: 1366449720
Provider Name (Legal Business Name): CYNTHIA PAULSEN SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

15 10TH AVE NE
RIO RANCHO NM
87144-0726
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-2789
Mailing address:
  • Phone: 505-265-1711
  • Fax: 505-256-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15538
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: