Provider Demographics
NPI:1841599446
Name:FAULKNER, BART SUTHERLAND (PHARMD)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:SUTHERLAND
Last Name:FAULKNER
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 1:205 STATE HIGHWAY 30 W
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3111
Mailing Address - Country:US
Mailing Address - Phone:662-534-8181
Mailing Address - Fax:662-534-6255
Practice Address - Street 1:205 STATE HIGHWAY 30 W
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3111
Practice Address - Country:US
Practice Address - Phone:662-534-8181
Practice Address - Fax:662-534-6255
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist