Provider Demographics
NPI:1558949123
Name:SPALDING, CYNTHIA LOU
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOU
Last Name:SPALDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 CLEVELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3436
Mailing Address - Country:US
Mailing Address - Phone:618-409-1713
Mailing Address - Fax:
Practice Address - Street 1:1511 CAMP JACKSON RD
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2569
Practice Address - Country:US
Practice Address - Phone:618-332-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.035194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist