Provider Demographics
NPI:1558659904
Name:NEWSOME, SHANNON YVETTE (RPH)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:YVETTE
Last Name:NEWSOME
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 1:10346 BROOM LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2132
Mailing Address - Country:US
Mailing Address - Phone:202-247-1870
Mailing Address - Fax:
Practice Address - Street 1:6100 GREENBELT RD
Practice Address - Street 2:T1295
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4063
Practice Address - Country:US
Practice Address - Phone:301-837-0055
Practice Address - Fax:301-837-0055
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist