Provider Demographics
NPI:1336599018
Name:FAGER, CINDY (RPH)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:FAGER
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 1:14129 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-9546
Mailing Address - Country:US
Mailing Address - Phone:231-499-0781
Mailing Address - Fax:
Practice Address - Street 1:124 AMES ST STE 1
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-9449
Practice Address - Country:US
Practice Address - Phone:231-264-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315159937183500000X
MI5302039742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist