Healthcare Provider Details

I. General information

NPI: 1700600194
Provider Name (Legal Business Name): CYNTHIA RIDDAGH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MOREHEAD MEDICAL DR
CHARLOTTE NC
28204-2990
US

IV. Provider business mailing address

16845 HARBOR VIEW RD
CHARLOTTE NC
28278-0135
US

V. Phone/Fax

Practice location:
  • Phone: 980-442-4229
  • Fax:
Mailing address:
  • Phone: 631-365-3237
  • Fax: 980-442-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number20217
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: