Provider Demographics
NPI:1235369232
Name:CRIDER, CATHY M (RPH)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:M
Last Name:CRIDER
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 1:436 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3602
Mailing Address - Country:US
Mailing Address - Phone:217-224-2828
Mailing Address - Fax:217-224-3608
Practice Address - Street 1:436 N 30TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3602
Practice Address - Country:US
Practice Address - Phone:217-224-2828
Practice Address - Fax:217-224-3608
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist