1982752549 NPI number — CUNNINGHAM DRUGS

Table of content: (NPI 1982752549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982752549 NPI number — CUNNINGHAM DRUGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUNNINGHAM DRUGS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982752549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 HWY 11 E
Provider Second Line Business Mailing Address:
PO BOX 127
Provider Business Mailing Address City Name:
BULLS GAP
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 HWY 11 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULLS GAP
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-235-6263
Provider Business Practice Location Address Fax Number:
423-235-4792
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CUNNINGHAM
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND PHRM
Authorized Official Telephone Number:
423-235-6263

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  2211 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1452421 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4426183 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com