Provider Demographics
NPI:1497195234
Name:ABERNATHY, CYNTHIA DIANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:ABERNATHY
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 1:1721 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4949
Mailing Address - Country:US
Mailing Address - Phone:636-332-4456
Mailing Address - Fax:
Practice Address - Street 1:2979 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7862
Practice Address - Country:US
Practice Address - Phone:636-379-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist