Provider Demographics
NPI:1982748034
Name:SOUTHERLAND, CHARLIE ANTHONY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:ANTHONY
Last Name:SOUTHERLAND
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:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-1191
Mailing Address - Country:US
Mailing Address - Phone:865-397-2868
Mailing Address - Fax:865-397-5100
Practice Address - Street 1:127 W MEETING ST
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4747
Practice Address - Country:US
Practice Address - Phone:865-397-2868
Practice Address - Fax:865-397-5100
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist