Provider Demographics
NPI:1972827293
Name:PORTER, CINDY SUE (RPH)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:SUE
Last Name:PORTER
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 1:2150 N LINCOLN PARK W
Mailing Address - Street 2:#1411
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4652
Mailing Address - Country:US
Mailing Address - Phone:773-828-4480
Mailing Address - Fax:
Practice Address - Street 1:2150 N LINCOLN PARK W
Practice Address - Street 2:#1411
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4652
Practice Address - Country:US
Practice Address - Phone:773-828-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510342741835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric