Provider Demographics
NPI:1619630530
Name:NEWTON, CARSI
Entity Type:Individual
Prefix:
First Name:CARSI
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16115 STATE HIGHWAY 152
Mailing Address - Street 2:
Mailing Address - City:BINGER
Mailing Address - State:OK
Mailing Address - Zip Code:73009-5074
Mailing Address - Country:US
Mailing Address - Phone:580-886-5245
Mailing Address - Fax:
Practice Address - Street 1:1550 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5852
Practice Address - Country:US
Practice Address - Phone:405-252-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist