Provider Demographics
NPI:1013269778
Name:NEWMAN, JORDAN ROYCE (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROYCE
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-1412
Mailing Address - Country:US
Mailing Address - Phone:616-452-3142
Mailing Address - Fax:616-248-2665
Practice Address - Street 1:1540 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1412
Practice Address - Country:US
Practice Address - Phone:616-452-3142
Practice Address - Fax:616-248-2665
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039457183500000X
KY016647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist