Provider Demographics
NPI:1194006767
Name:SUTTIN, JERRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:SUTTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 CHARING CROSS RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4035
Mailing Address - Country:US
Mailing Address - Phone:847-945-4667
Mailing Address - Fax:847-945-4668
Practice Address - Street 1:63 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-4416
Practice Address - Country:US
Practice Address - Phone:847-835-8417
Practice Address - Fax:847-835-1749
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051027693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist