Provider Demographics
NPI:1033639182
Name:NEWELL, DESIRAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 CR 577
Mailing Address - Street 2:
Mailing Address - City:CENTER HILL
Mailing Address - State:FL
Mailing Address - Zip Code:33514-4540
Mailing Address - Country:US
Mailing Address - Phone:352-457-7386
Mailing Address - Fax:
Practice Address - Street 1:2163 W C 48
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-8999
Practice Address - Country:US
Practice Address - Phone:352-793-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist