Provider Demographics
NPI:1154600252
Name:SUTTON, JENNIFER ALPHIN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALPHIN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 NC 111 HWY S
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9253
Mailing Address - Country:US
Mailing Address - Phone:919-778-1110
Mailing Address - Fax:919-778-1038
Practice Address - Street 1:223 NC 111 HWY S
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9253
Practice Address - Country:US
Practice Address - Phone:919-778-1110
Practice Address - Fax:919-778-1038
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist