Provider Demographics
NPI:1760458848
Name:NEWMAN PHARMACY/MEDISTAT
Entity Type:Organization
Organization Name:NEWMAN PHARMACY/MEDISTAT
Other - Org Name:A&R PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAINE
Authorized Official - Middle Name:BLEDSOE
Authorized Official - Last Name:PLEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-450-0808
Mailing Address - Street 1:755B MCRAE AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4538
Mailing Address - Country:US
Mailing Address - Phone:251-450-0808
Mailing Address - Fax:251-471-3673
Practice Address - Street 1:R2 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6461
Practice Address - Country:US
Practice Address - Phone:787-286-8545
Practice Address - Fax:787-286-8547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2006003892333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51060781OtherBLUE CROSS BLUE SHIELD
AL1252190002Medicare ID - Type UnspecifiedPROVIDER NUMBER