Provider Demographics
NPI:1003193780
Name:CUNNINGHAM, MICHELLE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:CUNNINGHAM
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 1:192 N MAIN ST
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3462
Mailing Address - Country:US
Mailing Address - Phone:920-922-9634
Mailing Address - Fax:920-921-2760
Practice Address - Street 1:192 N MAIN ST
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3462
Practice Address - Country:US
Practice Address - Phone:920-922-9634
Practice Address - Fax:920-921-2760
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist