Provider Demographics
NPI:1053686220
Name:NEWMAN, FRED JEWEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:JEWEL
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3059
Mailing Address - Country:US
Mailing Address - Phone:206-781-2703
Mailing Address - Fax:206-781-2691
Practice Address - Street 1:8540 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3059
Practice Address - Country:US
Practice Address - Phone:206-781-2703
Practice Address - Fax:206-781-2691
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist