Provider Demographics
NPI:1124105184
Name:NEWBERN, GERALD LANE (RPH)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LANE
Last Name:NEWBERN
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 1:144 S SEQUOIA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1462
Mailing Address - Country:US
Mailing Address - Phone:256-767-0441
Mailing Address - Fax:256-767-2055
Practice Address - Street 1:1702 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2153
Practice Address - Country:US
Practice Address - Phone:256-767-3100
Practice Address - Fax:256-767-2055
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist