Active NPI
Michelle M Cunningham, RPH
- Pharmacist
- Fond Du Lac, WI
National Provider Identifier
1003193780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12013
- Practice address
- 192 N Main St
Walgreens Pharmacy
Fond Du Lac, WI 54935-3462 - Phone
- (920) 922-9634
- Fax
- (920) 921-2760
- NPI assigned
- Nov 9, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12013 | WI | Primary |
Addresses
Primary practice location
192 N Main St
Walgreens Pharmacy
Fond Du Lac, WI 54935-3462
Mailing address
192 N Main St
Walgreens Pharmacy
Fond Du Lac, WI 54935-3462
Phone (920) 922-9634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320796800000",
"number": "1003193780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "192 N MAIN ST",
"address_2": "WALGREENS PHARMACY",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353462",
"telephone_number": "920-922-9634",
"fax_number": "920-921-2760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "192 N MAIN ST",
"address_2": "WALGREENS PHARMACY",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353462",
"telephone_number": "920-922-9634",
"fax_number": "920-921-2760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUNNINGHAM",
"first_name": "MICHELLE",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-09",
"last_updated": "2011-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "12013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.