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General NPI Number Information
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NPI Number | 1124439310
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Entity Type | Individual
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Provider Name | LEE OWEN CUNNINGHAM JR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2014
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Last Update Date | 05/11/2014
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Provider Practice Location Address
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Address Line | 5571 N GRETNA RD
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City | BRANSON
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State | MO
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Zip | 65616-7287
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Country | US
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Telephone | 417-243-2300
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Fax | 417-243-2390
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Provider Business Mailing Address
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Address Line | 1100 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1944
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Country | US
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Telephone | 479-587-5919
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Fax | 479-587-5887
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 044600
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License Number State | MO
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