Provider Demographics
NPI:1841693983
Name:PHYSICIANS RX PHARMACY OF NEWMAN LLC
Entity type:Organization
Organization Name:PHYSICIANS RX PHARMACY OF NEWMAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-789-9288
Mailing Address - Street 1:C/O D CUTULI
Mailing Address - Street 2:KOPPERS BUILDING 6TH FLOOR, 436 SEVENTH AVENUE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219
Mailing Address - Country:US
Mailing Address - Phone:412-391-2920
Mailing Address - Fax:412-391-4703
Practice Address - Street 1:770 GREISON TRL
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6408
Practice Address - Country:US
Practice Address - Phone:404-870-7748
Practice Address - Fax:800-466-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0101013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148230OtherPK
GA003154724AMedicaid