Provider Demographics
NPI:1760251912
Name:NEWBY, WANETTE HAIZE (PHARMD)
Entity Type:Individual
Prefix:
First Name:WANETTE
Middle Name:HAIZE
Last Name:NEWBY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 KEW CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5891
Mailing Address - Country:US
Mailing Address - Phone:706-495-2654
Mailing Address - Fax:
Practice Address - Street 1:4223 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3069
Practice Address - Country:US
Practice Address - Phone:706-869-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist