Healthcare Provider Details

I. General information

NPI: 1477029312
Provider Name (Legal Business Name): COURTNEY JADE NEWBY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELING ST
AURORA CO
80045-7211
US

IV. Provider business mailing address

335 RIDGEWOOD DR
HAWESVILLE KY
42348-2564
US

V. Phone/Fax

Practice location:
  • Phone: 270-922-1021
  • Fax:
Mailing address:
  • Phone: 270-922-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number018790
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: