MEDICARE: DM SUTHERLAND CO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336L0003X	Long Term Care Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	209950	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2027276	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720182785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DM SUTHERLAND CO LLC

Provider Business Mailing Address
First Line	:	520 W BERTRAND AVE
Second Line	:
City	:	SAINT MARYS
State	:	KS
Zip	:	66536-1695
Country	:	US
Telephone Number	:	785-437-2967
Fax Number	:	785-437-2606

Provider Business Practice Location Address
First Line	:	520 W BERTRAND AVE
Second Line	:
City	:	SAINT MARYS
State	:	KS
Zip	:	66536-1695
Country	:	US
Telephone Number	:	785-437-2967
Fax Number	:	785-437-2606

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL SUTHERLAND
Credential	:	RPH
Telephone Number	:	785-437-2967

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	12/06/2016

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Directions to “DM SUTHERLAND CO LLC ” Practice Location

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