Provider Demographics
NPI:1730964255
Name:FAIN, CINDY R
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:R
Last Name:FAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3048
Mailing Address - Country:US
Mailing Address - Phone:405-737-7467
Mailing Address - Fax:405-737-7457
Practice Address - Street 1:6521 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3048
Practice Address - Country:US
Practice Address - Phone:405-737-7467
Practice Address - Fax:405-737-7457
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10979183500000X
ARPD14242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist