Healthcare Provider Details

I. General information

NPI: 1306026463
Provider Name (Legal Business Name): JERRY GENE NEWMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CHURCH ST
BIRMINGHAM AL
35213-3701
US

IV. Provider business mailing address

57 CHURCH ST
BIRMINGHAM AL
35213-3701
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-2196
  • Fax: 205-871-6845
Mailing address:
  • Phone: 205-871-2196
  • Fax: 205-871-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6427
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: