Provider Demographics
NPI:1568786457
Name:BODROGI, CYNTHYA GISELLA (RPH)
Entity Type:Individual
Prefix:
First Name:CYNTHYA
Middle Name:GISELLA
Last Name:BODROGI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CYNTHYA
Other - Middle Name:GB
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:77 BRINKERHOFF ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2703
Mailing Address - Country:US
Mailing Address - Phone:518-561-1972
Mailing Address - Fax:
Practice Address - Street 1:28 MONTCALM AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1533
Practice Address - Country:US
Practice Address - Phone:518-563-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-21
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038008183500000X
VT0330003269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist