Provider Demographics
NPI:1881064806
Name:SUTHERLAND, WILLIAM B
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12606 BRENDA JEAN CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6589
Mailing Address - Country:US
Mailing Address - Phone:951-258-1576
Mailing Address - Fax:
Practice Address - Street 1:12606 BRENDA JEAN CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6589
Practice Address - Country:US
Practice Address - Phone:951-258-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist