Basic Information
Provider Information
NPI: 1619523578
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWMAN
FirstName: MARY
MiddleName: FRANCIS
NamePrefix:  
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1278 N LAFAYETTE DR
Address2:  
City: SUMTER
State: SC
PostalCode: 291502964
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1278 N LAFAYETTE DR
Address2:  
City: SUMTER
State: SC
PostalCode: 291502964
CountryCode: US
TelephoneNumber: 8037744500
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/15/2019
LastUpdateDate: 08/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X42082SCY Pharmacy Service ProvidersPharmacist 

No ID Information.


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