MEDICARE: TAVARES DEON CUNNINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	41873	TX

General Provider Information

NPI Number	:	1376871244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAVARES DEON CUNNINGHAM

Provider Business Mailing Address
First Line	:	3210 HILLCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5806
Country	:	US
Telephone Number	:	832-242-1735
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 HILLCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5806
Country	:	US
Telephone Number	:	832-242-1735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	12/03/2009

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Directions to “ TAVARES DEON CUNNINGHAM ” Practice Location

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