Provider Demographics
NPI:1114249547
Name:CUNNINGHAM, GAYLE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:MARIE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:GAYLE
Other - Middle Name:MARIE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2503 FARMERS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3814
Mailing Address - Country:US
Mailing Address - Phone:516-804-3788
Mailing Address - Fax:
Practice Address - Street 1:2503 FARMERS AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3814
Practice Address - Country:US
Practice Address - Phone:516-804-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist