Provider Demographics
NPI:1437413457
Name:SUTHERLAND, TRENT T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:T
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 BEN VENUE RD
Mailing Address - Street 2:
Mailing Address - City:FLINT HILL
Mailing Address - State:VA
Mailing Address - Zip Code:22627-1809
Mailing Address - Country:US
Mailing Address - Phone:540-905-9195
Mailing Address - Fax:
Practice Address - Street 1:690 BEN VENUE RD
Practice Address - Street 2:
Practice Address - City:FLINT HILL
Practice Address - State:VA
Practice Address - Zip Code:22627-1809
Practice Address - Country:US
Practice Address - Phone:540-905-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204391183500000X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy