Provider Demographics
NPI:1548802481
Name:NEWSOM, NANCY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
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 1:876 E 800 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3634
Mailing Address - Country:US
Mailing Address - Phone:801-355-5257
Mailing Address - Fax:801-363-3761
Practice Address - Street 1:876 E 800 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3634
Practice Address - Country:US
Practice Address - Phone:801-355-5257
Practice Address - Fax:801-363-6731
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT323584-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist