Provider Demographics
NPI:1134725930
Name:OYUGA NEWBY, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:OYUGA NEWBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13066 NITTANY LION CIR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-3611
Mailing Address - Country:US
Mailing Address - Phone:443-204-5171
Mailing Address - Fax:
Practice Address - Street 1:34 N CANNON AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4919
Practice Address - Country:US
Practice Address - Phone:301-797-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist