Healthcare Provider Details

I. General information

NPI: 1013513100
Provider Name (Legal Business Name): GARY EDWARD SUTTERLIN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2020
Last Update Date: 12/05/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2567 MILL RD
DOYLESTOWN PA
18902-1661
US

IV. Provider business mailing address

2567 MILL RD
DOYLESTOWN PA
18902-1661
US

V. Phone/Fax

Practice location:
  • Phone: 215-534-1371
  • Fax: 215-794-8050
Mailing address:
  • Phone: 215-534-1371
  • Fax: 215-794-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPI005083
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP038686L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: