Healthcare Provider Details

I. General information

NPI: 1376691006
Provider Name (Legal Business Name): JOE D. NEWTON REGISTER PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 FOREST TRL
ISLE OF PALMS SC
29451-2519
US

IV. Provider business mailing address

253 FOREST TRL
ISLE OF PALMS SC
29451-2519
US

V. Phone/Fax

Practice location:
  • Phone: 843-886-8470
  • Fax: 843-876-0263
Mailing address:
  • Phone: 843-886-8470
  • Fax: 843-876-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3550
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: