Provider Demographics
NPI:1407987068
Name:NEWSOM, AMANDA IRENE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:IRENE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20269 E SMOKY HILL RD
Mailing Address - Street 2:SUITE B-119
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3111
Mailing Address - Country:US
Mailing Address - Phone:720-935-8410
Mailing Address - Fax:
Practice Address - Street 1:16921 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6132
Practice Address - Country:US
Practice Address - Phone:720-935-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15465183500000X
OR8283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist