Provider Demographics
NPI:1972706414
Name:SUTHERLAND, JONATHAN K (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:K
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 LOCKHART FLATS LOOP
Mailing Address - Street 2:PO BOX 1844
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228
Mailing Address - Country:US
Mailing Address - Phone:276-926-8080
Mailing Address - Fax:276-926-6602
Practice Address - Street 1:RITE AID #1396
Practice Address - Street 2:CORNER OF HWY 83 & BRUSH CREEK RD
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228
Practice Address - Country:US
Practice Address - Phone:276-926-6555
Practice Address - Fax:276-926-6602
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist