Provider Demographics
NPI:1871687202
Name:NEWTS PHARMACY LLC
Entity Type:Organization
Organization Name:NEWTS PHARMACY LLC
Other - Org Name:MELVIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEWTON
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-566-2281
Mailing Address - Street 1:1558 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5033
Mailing Address - Country:US
Mailing Address - Phone:617-566-2281
Mailing Address - Fax:617-232-4084
Practice Address - Street 1:1558 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5033
Practice Address - Country:US
Practice Address - Phone:617-566-2281
Practice Address - Fax:617-232-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11020839Medicaid
MA0406261Medicaid