Provider Demographics
NPI:1912252776
Name:NEWSOME, KASSIE DENISE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KASSIE
Middle Name:DENISE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1247
Mailing Address - Country:US
Mailing Address - Phone:606-794-8916
Mailing Address - Fax:
Practice Address - Street 1:308 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1247
Practice Address - Country:US
Practice Address - Phone:606-794-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist