Provider Demographics
NPI:1255527388
Name:MENDE, CYNTHIA A (RPH)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:MENDE
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 1:3001 S VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6405
Mailing Address - Country:US
Mailing Address - Phone:217-793-4091
Mailing Address - Fax:217-793-6468
Practice Address - Street 1:1903 W MONROE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1530
Practice Address - Country:US
Practice Address - Phone:217-787-2830
Practice Address - Fax:217-787-4520
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist