Provider Demographics
NPI:1023613023
Name:CUNNINGHAM, WILLIAM GLENN JR (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GLENN
Last Name:CUNNINGHAM
Suffix:JR
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 1:896 JOHN CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7408
Mailing Address - Country:US
Mailing Address - Phone:404-543-2668
Mailing Address - Fax:
Practice Address - Street 1:620 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7699
Practice Address - Country:US
Practice Address - Phone:770-339-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA013633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist