=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669354585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN DALE CUNNINGHAM PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2025
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3014 ALLISON BONNETT MEMORIAL DR STE 130
-----------------------------------------------------
City | HUEYTOWN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35023-2395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-497-5372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2727 BRIARBERRY CIR APT A
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35226-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-777-1538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 24189
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------