MEDICARE: NEWMAN PHARMACY/MEDISTAT

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	333600000X	Pharmacy	2006003892	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51060781	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1760458848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWMAN PHARMACY/MEDISTAT

Provider Business Mailing Address
First Line	:	755B MCRAE AVE
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-4538
Country	:	US
Telephone Number	:	251-450-0808
Fax Number	:	251-471-3673

Provider Business Practice Location Address
First Line	:	R2 AVE LUIS MUNOZ MARIN
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-6461
Country	:	US
Telephone Number	:	787-286-8545
Fax Number	:	787-286-8547

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MRS. JAINE BLEDSOE PLEDGER
Credential	:
Telephone Number	:	251-450-0808

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/22/2020

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Directions to “NEWMAN PHARMACY/MEDISTAT ” Practice Location

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