Provider Demographics
NPI:1528560208
Name:MONTGOMERY, SUNNY REED (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:REED
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 JOE TILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:DECATURVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38329-4604
Mailing Address - Country:US
Mailing Address - Phone:731-733-8538
Mailing Address - Fax:
Practice Address - Street 1:1458 JOE TILLMAN RD
Practice Address - Street 2:
Practice Address - City:DECATURVILLE
Practice Address - State:TN
Practice Address - Zip Code:38329-4604
Practice Address - Country:US
Practice Address - Phone:731-733-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN342801835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric