Provider Demographics
NPI:1316338726
Name:NEWMAN, GARY JACK (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JACK
Last Name:NEWMAN
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 1:2800 PINE ST
Mailing Address - Street 2:PINE PLAZA #5
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5321
Mailing Address - Country:US
Mailing Address - Phone:870-246-2015
Mailing Address - Fax:870-246-2915
Practice Address - Street 1:2800 PINE ST
Practice Address - Street 2:PINE PLAZA #5
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5321
Practice Address - Country:US
Practice Address - Phone:870-246-2015
Practice Address - Fax:870-246-2915
Is Sole Proprietor?:No
Enumeration Date:2015-02-08
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR06642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist