Provider Demographics
NPI:1518579051
Name:SUTHERLAND, JENNIFER MOORE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MOORE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MOORE
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9424
Mailing Address - Country:US
Mailing Address - Phone:270-524-3081
Mailing Address - Fax:270-524-1050
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9424
Practice Address - Country:US
Practice Address - Phone:270-524-3081
Practice Address - Fax:270-524-1050
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist