Provider Demographics
NPI:1447459391
Name:SUTHERLAND, KATHLEEN (RPH, BS)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:RPH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4478 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2931
Mailing Address - Country:US
Mailing Address - Phone:941-235-1120
Mailing Address - Fax:941-235-1853
Practice Address - Street 1:4478 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33980-2931
Practice Address - Country:US
Practice Address - Phone:941-235-1120
Practice Address - Fax:941-235-1853
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38205183500000X
RIRPH04074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist