Provider Demographics
NPI:1932422805
Name:COTTRELL, CINDY MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:MARIE
Last Name:COTTRELL
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 1:3808 BRADY ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-6008
Mailing Address - Country:US
Mailing Address - Phone:563-391-8587
Mailing Address - Fax:563-391-8921
Practice Address - Street 1:3808 BRADY ST
Practice Address - Street 2:PHARMACY
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-6008
Practice Address - Country:US
Practice Address - Phone:563-391-8587
Practice Address - Fax:563-391-8921
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17694183500000X
IL051.039286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.039286OtherLICENSE #
IA17694OtherPHARMACY LICENSE #