Provider Demographics
NPI:1811205172
Name:CUNNINGHAM, PATRICIA ANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9479
Mailing Address - Country:US
Mailing Address - Phone:607-324-1353
Mailing Address - Fax:
Practice Address - Street 1:210 N FRANKLIN ST FL 2
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1224
Practice Address - Country:US
Practice Address - Phone:607-535-4999
Practice Address - Fax:607-535-4320
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI031718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist