=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821684218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AVA D NEWMAN R.PH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2020
-----------------------------------------------------
Last Update Date | 12/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 256 N SAM HOUSTON PKWY E STE 203
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77060-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-328-0923
-----------------------------------------------------
Fax | 346-570-4911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7202 FALL SPRINGS LN
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77396-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-372-3607
-----------------------------------------------------
Fax | 346-570-4911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 32197
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------