Provider Demographics
NPI:1821433632
Name:SUTHERLAND, DIANN LOUISE (BSP MSC)
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:LOUISE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:BSP MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:STE 227
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4730
Mailing Address - Country:US
Mailing Address - Phone:919-847-7645
Mailing Address - Fax:919-847-7641
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:STE 227
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-847-7645
Practice Address - Fax:919-847-7641
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23151OtherNC BOARD OF PHARMACY LICENSE NUMBER