Provider Demographics
NPI:1891212221
Name:NEWSOME-PITTMAN, LAVARSHIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAVARSHIA
Middle Name:
Last Name:NEWSOME-PITTMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LAVARSHIA
Other - Middle Name:
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3000 PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667
Mailing Address - Country:US
Mailing Address - Phone:601-876-2152
Mailing Address - Fax:601-876-2122
Practice Address - Street 1:3000 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667
Practice Address - Country:US
Practice Address - Phone:601-876-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-08988183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE-08988OtherPHARMACY LICENSE