Provider Demographics
NPI:1649390618
Name:NEWMAN, GARY LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:NEWMAN
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 1:21 MELISSA LEE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5150
Mailing Address - Country:US
Mailing Address - Phone:732-730-0040
Mailing Address - Fax:732-239-4754
Practice Address - Street 1:21 MELISSA LEE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5150
Practice Address - Country:US
Practice Address - Phone:732-730-0040
Practice Address - Fax:732-239-4754
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01699300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist