Provider Demographics
NPI:1982752549
Name:CUNNINGHAM DRUGS
Entity Type:Organization
Organization Name:CUNNINGHAM DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHRM
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:423-235-6263
Mailing Address - Street 1:411 HWY 11 E
Mailing Address - Street 2:PO BOX 127
Mailing Address - City:BULLS GAP
Mailing Address - State:TN
Mailing Address - Zip Code:37711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 HWY 11 E
Practice Address - Street 2:
Practice Address - City:BULLS GAP
Practice Address - State:TN
Practice Address - Zip Code:37711
Practice Address - Country:US
Practice Address - Phone:423-235-6263
Practice Address - Fax:423-235-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2211333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452421Medicaid
4426183OtherOTHER ID NUMBER-COMMERCIAL NUMBER