MEDICARE: CYNTHIA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11317	CO

General Provider Information

NPI Number	:	1295156560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA SMITH

Provider Business Mailing Address
First Line	:	1173 BERGEN PKWY
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-9522
Country	:	US
Telephone Number	:	303-674-8246
Fax Number	:	303-670-6840

Provider Business Practice Location Address
First Line	:	1173 BERGEN PKWY
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-9522
Country	:	US
Telephone Number	:	303-674-8246
Fax Number	:	303-670-6840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	01/03/2014

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Directions to “ CYNTHIA SMITH ” Practice Location

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