Provider Demographics
NPI:1811243520
Name:NEWBERRY, LISA LEANN (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEANN
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:SULLIVAN
Other - Last Name:JALOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5245 SEWELL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4032
Mailing Address - Country:US
Mailing Address - Phone:850-266-1883
Mailing Address - Fax:
Practice Address - Street 1:4311 BAYOU BLVD APT A8
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2621
Practice Address - Country:US
Practice Address - Phone:850-629-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist