Healthcare Provider Details

I. General information

NPI: 1417380734
Provider Name (Legal Business Name): CYNTHIA DAGGY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2013
Last Update Date: 08/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 E OAKLAND AVE
BLOOMINGTON IL
61701-5760
US

IV. Provider business mailing address

2203 E OAKLAND AVE
BLOOMINGTON IL
61701-5760
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-4012
  • Fax:
Mailing address:
  • Phone: 309-663-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051296881
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: