Provider Demographics
NPI:1871707398
Name:THAYER, CYNTHIA ANN (RPH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:THAYER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 INTERSTATE BLVD
Mailing Address - Street 2:
Mailing Address - City:HARWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58042-4001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 38TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2955
Practice Address - Country:US
Practice Address - Phone:701-893-9217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3878183500000X
SDR4207183500000X
MN113622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist