Provider Demographics
NPI:1790049542
Name:NEWELL, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:NEWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6764 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-2252
Mailing Address - Country:US
Mailing Address - Phone:810-765-3585
Mailing Address - Fax:810-765-3590
Practice Address - Street 1:6764 RIVER RD
Practice Address - Street 2:
Practice Address - City:COTTRELLVILLE
Practice Address - State:MI
Practice Address - Zip Code:48039-2252
Practice Address - Country:US
Practice Address - Phone:810-765-3585
Practice Address - Fax:810-765-3590
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist