Provider Demographics
NPI:1114204898
Name:LEW, TOMMY H (RPH)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:H
Last Name:LEW
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 1:400 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4367
Mailing Address - Country:US
Mailing Address - Phone:208-529-5300
Mailing Address - Fax:209-529-0940
Practice Address - Street 1:400 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4367
Practice Address - Country:US
Practice Address - Phone:208-529-5300
Practice Address - Fax:209-529-0940
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPH4207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist