Provider Demographics
NPI:1437600210
Name:NEWMAN, STACI (PHARM D)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 4TH ST NW STE G
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6675
Mailing Address - Country:US
Mailing Address - Phone:505-358-7155
Mailing Address - Fax:866-333-9771
Practice Address - Street 1:7103 4TH ST NW STE G
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6675
Practice Address - Country:US
Practice Address - Phone:505-358-7155
Practice Address - Fax:866-333-9771
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist