Provider Demographics
NPI:1124303565
Name:NEWSOME, COURTNEY NICHELLE (RPH)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:NICHELLE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 NEW PARIS WAY
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-7262
Mailing Address - Country:US
Mailing Address - Phone:941-725-0147
Mailing Address - Fax:
Practice Address - Street 1:6107 NEW PARIS WAY
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-7262
Practice Address - Country:US
Practice Address - Phone:941-725-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist