Provider Demographics
NPI:1841572666
Name:SUTHERLAND, DEREK CHARLES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:CHARLES
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 1:3531 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1233
Mailing Address - Country:US
Mailing Address - Phone:276-620-9370
Mailing Address - Fax:
Practice Address - Street 1:4299 UNION DEPOSIT RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2802
Practice Address - Country:US
Practice Address - Phone:717-564-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207557183500000X
PARP449440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist