Provider Demographics
NPI:1447541503
Name:NEWSOME, JOHNNA BRIANNE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JOHNNA
Middle Name:BRIANNE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 KY RT 122
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649
Mailing Address - Country:US
Mailing Address - Phone:606-285-9908
Mailing Address - Fax:606-285-9807
Practice Address - Street 1:262 KY RT 122
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-285-9908
Practice Address - Fax:606-285-9807
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist