Provider Demographics
NPI:1760980692
Name:SUDDARTH, KAREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SUDDARTH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-5207
Mailing Address - Country:US
Mailing Address - Phone:931-424-5584
Mailing Address - Fax:931-424-9534
Practice Address - Street 1:1655 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-5207
Practice Address - Country:US
Practice Address - Phone:931-424-5584
Practice Address - Fax:931-424-9534
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12169OtherTN STATE BOARD OF PHARMACY