Provider Demographics
NPI:1184916900
Name:CUNNINGHAM ROWE, VICKI LYNN
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNN
Last Name:CUNNINGHAM ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1153 ROWE RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-5951
Mailing Address - Country:US
Mailing Address - Phone:423-626-4742
Mailing Address - Fax:
Practice Address - Street 1:1153 ROWE RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-5951
Practice Address - Country:US
Practice Address - Phone:423-626-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist