Provider Demographics
NPI:1063780716
Name:LEWIS, KATIE LOUISE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LOUISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:LOUISE
Other - Last Name:BOSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:101 W US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7337
Mailing Address - Country:US
Mailing Address - Phone:219-879-9650
Mailing Address - Fax:219-879-9687
Practice Address - Street 1:101 W US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7337
Practice Address - Country:US
Practice Address - Phone:219-879-9650
Practice Address - Fax:219-879-9687
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021111A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist