Provider Demographics
NPI:1649890104
Name:CUNNINGHAM, KIMBERLY ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:CUNNINGHAM
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 1:5993 E BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-9733
Mailing Address - Country:US
Mailing Address - Phone:317-919-1789
Mailing Address - Fax:
Practice Address - Street 1:5993 E BOULDER DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-9733
Practice Address - Country:US
Practice Address - Phone:317-919-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023346A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist