Provider Demographics
NPI:1184216939
Name:NEWSOME, STEVIE (BS PHARM)
Entity Type:Individual
Prefix:
First Name:STEVIE
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0700
Mailing Address - Country:US
Mailing Address - Phone:606-377-1088
Mailing Address - Fax:606-377-2626
Practice Address - Street 1:9549 KY RT 122
Practice Address - Street 2:
Practice Address - City:MCDOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647
Practice Address - Country:US
Practice Address - Phone:606-377-1088
Practice Address - Fax:606-377-2626
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist