Provider Demographics
NPI:1922326362
Name:SUTHERLAND, MARY KOLB (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KOLB
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 AUTUMN PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3340
Mailing Address - Country:US
Mailing Address - Phone:615-308-5314
Mailing Address - Fax:888-836-8822
Practice Address - Street 1:305 SEABOARD LN
Practice Address - Street 2:SUITE 318
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8287
Practice Address - Country:US
Practice Address - Phone:888-836-8821
Practice Address - Fax:888-836-8822
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10290OtherPHARMACIST LICENSE NUMBER