Healthcare Provider Details

I. General information

NPI: 1285036095
Provider Name (Legal Business Name): DAN NEWSOM PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3423 CYPRESS ST
WEST MONROE LA
71291-7309
US

IV. Provider business mailing address

3423 CYPRESS ST
WEST MONROE LA
71291-7309
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-2994
  • Fax:
Mailing address:
  • Phone: 318-322-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19869
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: