Healthcare Provider Details

I. General information

NPI: 1134690159
Provider Name (Legal Business Name): CYNTHIA ANN OBUS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 1ST ST
SONORA TX
76950-7036
US

IV. Provider business mailing address

PO BOX 854
SONORA TX
76950-0854
US

V. Phone/Fax

Practice location:
  • Phone: 856-332-5978
  • Fax:
Mailing address:
  • Phone: 856-332-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02672900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: