Provider Demographics
NPI:1558669416
Name:NEWKIRK, MARY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:NEWKIRK
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 1:618 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6707
Mailing Address - Country:US
Mailing Address - Phone:864-962-1839
Mailing Address - Fax:864-962-1805
Practice Address - Street 1:618 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6707
Practice Address - Country:US
Practice Address - Phone:864-962-1839
Practice Address - Fax:864-962-1805
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist