Provider Demographics
NPI:1629379854
Name:NEWLIN, RUSSELL ROY (RPH)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ROY
Last Name:NEWLIN
Suffix:
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 1:560 E CASTLE PINES PKWY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-4606
Mailing Address - Country:US
Mailing Address - Phone:303-663-0791
Mailing Address - Fax:303-814-9520
Practice Address - Street 1:560 E CASTLE PINES PKWY
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-4606
Practice Address - Country:US
Practice Address - Phone:303-663-0791
Practice Address - Fax:303-814-9520
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist