Healthcare Provider Details

I. General information

NPI: 1023493376
Provider Name (Legal Business Name): CHRISTOPHER EDGAR NEWELL PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 CASCADE RD SE
GRAND RAPIDS MI
49546-3674
US

IV. Provider business mailing address

1349 EMERALD AVE NE
GRAND RAPIDS MI
49505-5226
US

V. Phone/Fax

Practice location:
  • Phone: 616-485-8174
  • Fax:
Mailing address:
  • Phone: 616-485-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040570
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: