Provider Demographics
NPI:1285168484
Name:ELLIOTT, CYNTHIA (RPH, CDE)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4298 STATE ROUTE 408 W
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:KY
Mailing Address - Zip Code:42051-9201
Mailing Address - Country:US
Mailing Address - Phone:270-970-0795
Mailing Address - Fax:270-251-4178
Practice Address - Street 1:4298 STATE ROUTE 408 W
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:KY
Practice Address - Zip Code:42051-9201
Practice Address - Country:US
Practice Address - Phone:270-970-0795
Practice Address - Fax:270-251-4178
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist