Provider Demographics
NPI:1346288115
Name:SUTHERLAND, CARL C (RPH)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:C
Last Name:SUTHERLAND
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 1:6521 DOWNS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1314
Mailing Address - Country:US
Mailing Address - Phone:502-239-8117
Mailing Address - Fax:502-287-6967
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-6178
Practice Address - Fax:502-287-6967
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist