Provider Demographics
NPI:1669993796
Name:NEWELL, AUSTIN KEITH
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:KEITH
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 1:305 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-6241
Mailing Address - Country:US
Mailing Address - Phone:843-423-9411
Mailing Address - Fax:
Practice Address - Street 1:305 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6241
Practice Address - Country:US
Practice Address - Phone:843-423-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37116333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy