Provider Demographics
NPI:1306026463
Name:NEWMAN, JERRY GENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:GENE
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 1:57 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-3701
Mailing Address - Country:US
Mailing Address - Phone:205-871-2196
Mailing Address - Fax:205-871-6845
Practice Address - Street 1:57 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-3701
Practice Address - Country:US
Practice Address - Phone:205-871-2196
Practice Address - Fax:205-871-6845
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0114291OtherNABP