Provider Demographics
NPI:1235998303
Name:RIDGEWAY, CYNTHIA DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DAWN
Last Name:RIDGEWAY
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 1:5225 WESCONNETT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7830
Mailing Address - Country:US
Mailing Address - Phone:614-560-6485
Mailing Address - Fax:
Practice Address - Street 1:5225 WESCONNETT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7830
Practice Address - Country:US
Practice Address - Phone:614-560-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist