Provider Demographics
NPI:1174805832
Name:NEWCOMER, CHANICE D
Entity type:Individual
Prefix:MRS
First Name:CHANICE
Middle Name:D
Last Name:NEWCOMER
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 1:8487 BENICASIM CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-4803
Mailing Address - Country:US
Mailing Address - Phone:702-655-7258
Mailing Address - Fax:702-655-7295
Practice Address - Street 1:8500 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7262
Practice Address - Country:US
Practice Address - Phone:702-655-7258
Practice Address - Fax:702-655-7295
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist