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General NPI Number Information
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NPI Number | 1760458848
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Entity Type | Organization
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Legal Business Name | NEWMAN PHARMACY/MEDISTAT
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | R2 AVE LUIS MUNOZ MARIN
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City | CAGUAS
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State | PR
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Zip | 00725-6461
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Country | US
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Telephone | 787-286-8545
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Fax | 787-286-8547
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Provider Business Mailing Address
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Address Line | 755B MCRAE AVE
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City | MOBILE
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State | AL
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Zip | 36606-4538
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Country | US
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Telephone | 251-450-0808
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Fax | 251-471-3673
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MRS. JAINE BLEDSOE PLEDGER
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Credential |
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Telephone | 251-450-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2006003892
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License Number State | AL
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