Provider Demographics
NPI:1518150382
Name:NEWMAN, JACK HUFF JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:HUFF
Last Name:NEWMAN
Suffix:JR
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 1:4027 RINER RD
Mailing Address - Street 2:PO BOX 198
Mailing Address - City:RINER
Mailing Address - State:VA
Mailing Address - Zip Code:24149-0198
Mailing Address - Country:US
Mailing Address - Phone:540-381-2833
Mailing Address - Fax:540-381-2834
Practice Address - Street 1:4027 RINER RD
Practice Address - Street 2:
Practice Address - City:RINER
Practice Address - State:VA
Practice Address - Zip Code:24149
Practice Address - Country:US
Practice Address - Phone:540-381-2833
Practice Address - Fax:540-381-2834
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1172290001Medicare PIN