Healthcare Provider Details

I. General information

NPI: 1922153923
Provider Name (Legal Business Name): CARLOS RALPH NEWCOMB D.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 FRISCO AVE
CLINTON OK
73601-3324
US

IV. Provider business mailing address

PO BOX 1775
CLINTON OK
73601-0536
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-2020
  • Fax: 580-323-3108
Mailing address:
  • Phone: 580-323-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7673
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: