1992820823 NPI number — MR. MICHAEL DILLON SUTHERLAND PHARM.D.

Table of content: MR. MICHAEL DILLON SUTHERLAND PHARM.D. (NPI 1992820823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992820823 NPI number — MR. MICHAEL DILLON SUTHERLAND PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTHERLAND
Provider First Name:
MICHAEL
Provider Middle Name:
DILLON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992820823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 PARK AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WISE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24293-5110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-328-2782
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11349 STATE HIGHWAY 1056
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCARR
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-427-9007
Provider Business Practice Location Address Fax Number:
606-427-9184
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  016414 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com