MEDICARE: NEWHALL PHARMACY INC

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
2	3336C0003X	Community/Retail Pharmacy	54078	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2137571	OTHER		PK

General Provider Information

NPI Number	:	1801140785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWHALL PHARMACY INC

Provider Business Mailing Address
First Line	:	24239 MAIN STREET
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321
Country	:	US
Telephone Number	:	661-799-7017
Fax Number	:	661-799-7021

Provider Business Practice Location Address
First Line	:	24239 MAIN ST
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2907
Country	:	US
Telephone Number	:	661-799-7017
Fax Number	:	661-799-7021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENISA CHOWDHURY
Credential	:
Telephone Number	:	661-816-8468

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	05/17/2018

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