Provider Demographics
NPI:1215262415
Name:MARKS, LEWIS (RPH)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:MARKS
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 1:11210 PROVIDENCE ROAD WEST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-815-3341
Mailing Address - Fax:704-815-3347
Practice Address - Street 1:11210 PROVIDENCE ROAD WEST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-815-3341
Practice Address - Fax:704-815-3347
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist