Provider Demographics
NPI:1407131329
Name:NEWPORT, VENTRESS SEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:VENTRESS
Middle Name:SEAN
Last Name:NEWPORT
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 1:3700 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4708
Mailing Address - Country:US
Mailing Address - Phone:504-488-1110
Mailing Address - Fax:504-488-1148
Practice Address - Street 1:3700 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4708
Practice Address - Country:US
Practice Address - Phone:504-488-1110
Practice Address - Fax:504-488-1148
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist