=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104555671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY NEWCOMB
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2022
-----------------------------------------------------
Last Update Date | 06/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 MAIN ST
-----------------------------------------------------
City | TOWNSEND
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01469-1033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-597-2392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 PERRY RD
-----------------------------------------------------
City | NEW IPSWICH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03071-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-302-0497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PHCY-01246
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH240606
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------