Healthcare Provider Details

I. General information

NPI: 1982785291
Provider Name (Legal Business Name): MICHAEL DAVID NEWMAN PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 US HIGHWAY 41 NW SUITE 13
JASPER FL
32052-5888
US

IV. Provider business mailing address

1150 US HIGHWAY 41 NW SUITE 13
JASPER FL
32052-5888
US

V. Phone/Fax

Practice location:
  • Phone: 386-792-3355
  • Fax: 386-792-3425
Mailing address:
  • Phone: 386-792-3355
  • Fax: 386-792-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS33564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: