Provider Demographics
NPI:1356408181
Name:NEWSON, JACK (RPH)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:NEWSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460
Mailing Address - Country:US
Mailing Address - Phone:812-829-2698
Mailing Address - Fax:
Practice Address - Street 1:235 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:IN
Practice Address - Zip Code:46120
Practice Address - Country:US
Practice Address - Phone:765-795-4100
Practice Address - Fax:765-795-5310
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012006A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist