Healthcare Provider Details

I. General information

NPI: 1295758928
Provider Name (Legal Business Name): PRISCILLA YVONNE NEWBON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SAINT JAMES CT
TALLAHASSEE FL
32308-5352
US

IV. Provider business mailing address

1038 EPPING FOREST DR
TALLAHASSEE FL
32317-8641
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-0191
  • Fax:
Mailing address:
  • Phone: 850-878-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number017818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: