Provider Demographics
NPI:1093867475
Name:NEWELL, ALECE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:ALECE
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3719
Mailing Address - Country:US
Mailing Address - Phone:580-353-4113
Mailing Address - Fax:580-357-3862
Practice Address - Street 1:802 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3719
Practice Address - Country:US
Practice Address - Phone:580-353-4113
Practice Address - Fax:580-357-3862
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10750183500000X
AL9817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist