Healthcare Provider Details

I. General information

NPI: 1104945658
Provider Name (Legal Business Name): CYNTHIA SCOTT EADY PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 W ARAPAHO RD STE 57
RICHARDSON TX
75080-5038
US

IV. Provider business mailing address

800 WATEKA WAY
RICHARDSON TX
75080-4013
US

V. Phone/Fax

Practice location:
  • Phone: 972-235-7133
  • Fax: 972-235-6968
Mailing address:
  • Phone: 972-235-7133
  • Fax: 972-235-6968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number3701-0106-0954-515
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: