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General NPI Number Information
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NPI Number | 1730483686
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Entity Type | Individual
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Provider Name | JACQUELINE DENISE NEWSOME RPH
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Gender | Female
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 951 DAVIE AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-5301
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Country | US
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Telephone | 704-873-6216
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Fax |
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Provider Business Mailing Address
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Address Line | 176 LAKE MIST DR
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City | MOORESVILLE
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State | NC
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Zip | 28117-3512
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Country | US
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Telephone | 704-578-2208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9939
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License Number State | NC
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