Provider Demographics
NPI:1104322411
Name:ANDERSON, CINDY A (RPH)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:A
Last Name:ANDERSON
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 1:10 WARRIOR LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9593
Mailing Address - Country:US
Mailing Address - Phone:515-987-8111
Mailing Address - Fax:515-987-8128
Practice Address - Street 1:10 WARRIOR LN
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9593
Practice Address - Country:US
Practice Address - Phone:515-987-8111
Practice Address - Fax:515-987-8128
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist