MEDICARE: DR. CYNTHIA G DERDEN PHARM D

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	42394	TX

General Provider Information

NPI Number	:	1831191311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA G DERDEN PHARM D

Provider Business Mailing Address
First Line	:	2990 GREENFIELD DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3648
Country	:	US
Telephone Number	:	972-231-2792
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 N SHILOH RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-2912
Country	:	US
Telephone Number	:	972-496-4403
Fax Number	:	972-496-4303

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

Provider Enumeration Date	:	08/13/2005
Last Update Date	:	07/08/2007

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