Provider Demographics
NPI:1689842247
Name:CUNNINGHAM, KEVIN DWAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DWAYNE
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838
Mailing Address - Country:US
Mailing Address - Phone:863-439-3511
Mailing Address - Fax:
Practice Address - Street 1:243 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838
Practice Address - Country:US
Practice Address - Phone:863-439-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist