Healthcare Provider Details

I. General information

NPI: 1720307184
Provider Name (Legal Business Name): CYNTHIA ANN MIZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 S 31ST ST
TEMPLE TX
76502-1802
US

IV. Provider business mailing address

462 WOODLAND POINT RD
BELTON TX
76513-6747
US

V. Phone/Fax

Practice location:
  • Phone: 254-773-2177
  • Fax:
Mailing address:
  • Phone: 254-780-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23766
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: