Provider Demographics
NPI:1962002410
Name:SUKUP, CATHERINE LOUISE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LOUISE
Last Name:SUKUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CYPRESS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8196
Mailing Address - Country:US
Mailing Address - Phone:504-616-1464
Mailing Address - Fax:
Practice Address - Street 1:8801 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-5901
Practice Address - Country:US
Practice Address - Phone:501-565-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist