Healthcare Provider Details

I. General information

NPI: 1801388244
Provider Name (Legal Business Name): CYNTHIA MARIE SJOBERG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 4TH ST NW
LOS RANCHOS NM
87114-1014
US

IV. Provider business mailing address

8225 4TH ST NW
LOS RANCHOS NM
87114-1014
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-2342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4957
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: