Healthcare Provider Details

I. General information

NPI: 1720227283
Provider Name (Legal Business Name): ERIC PAUL SUTHERLAND RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE VA MEDICAL CENTER
PROVIDENCE RI
02908
US

IV. Provider business mailing address

85 MARK DR
NORTH KINGSTOWN RI
02852-2427
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 401-767-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3663
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: