Provider Demographics
NPI:1518578475
Name:CUNNINGHAM, JOHN HAROLD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 S FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-8461
Mailing Address - Country:US
Mailing Address - Phone:850-689-0447
Mailing Address - Fax:850-689-0901
Practice Address - Street 1:2350 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-8461
Practice Address - Country:US
Practice Address - Phone:850-689-0447
Practice Address - Fax:850-689-0901
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist