Provider Demographics
NPI:1710073895
Name:CUNNINGHAM DRUG INC
Entity Type:Organization
Organization Name:CUNNINGHAM DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-352-2611
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:220 E 12TH ST
Mailing Address - City:SCHUYLER
Mailing Address - State:NE
Mailing Address - Zip Code:68661
Mailing Address - Country:US
Mailing Address - Phone:402-352-2611
Mailing Address - Fax:402-352-3898
Practice Address - Street 1:220 E 12TH ST
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661
Practice Address - Country:US
Practice Address - Phone:402-352-2611
Practice Address - Fax:402-352-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid