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General NPI Number Information
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NPI Number | 1982748034
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Entity Type | Individual
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Provider Name | CHARLIE ANTHONY SOUTHERLAND PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 01/29/2022
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Provider Practice Location Address
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Address Line | 127 W MEETING ST
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City | DANDRIDGE
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State | TN
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Zip | 37725-4747
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Country | US
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Telephone | 865-397-2868
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Fax | 865-397-5100
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Provider Business Mailing Address
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Address Line | PO BOX 1191
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City | DANDRIDGE
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State | TN
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Zip | 37725-1191
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Country | US
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Telephone | 865-397-2868
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Fax | 865-397-5100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21889
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License Number State | TN
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