Healthcare Provider Details

I. General information

NPI: 1417650904
Provider Name (Legal Business Name): CYNTHIA D HURLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20518 108TH AVE SE
KENT WA
98031-1542
US

IV. Provider business mailing address

32518 223RD AVE SE
BLACK DIAMOND WA
98010-1313
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-2999
  • Fax: 253-850-7631
Mailing address:
  • Phone: 360-886-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number00022561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: