Provider Demographics
NPI:1013239847
Name:WALTERS, CYNTHIA JANE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JANE
Last Name:WALTERS
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 1:6050 US HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5047
Mailing Address - Country:US
Mailing Address - Phone:219-762-6912
Mailing Address - Fax:
Practice Address - Street 1:6050 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5047
Practice Address - Country:US
Practice Address - Phone:219-762-6912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021113A183500000X
WV4760183500000X
GA16297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist