Provider Demographics
NPI:1285720136
Name:LEWIS, EDDIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CLAY
Other - Middle Name:EDWARD
Other - Last Name:LEWIS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1024 MIDDLE CREEK RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6921
Mailing Address - Country:US
Mailing Address - Phone:865-429-2051
Mailing Address - Fax:865-429-2258
Practice Address - Street 1:1024 MIDDLE CREEK RD
Practice Address - Street 2:SUITE #1
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6921
Practice Address - Country:US
Practice Address - Phone:865-429-2051
Practice Address - Fax:865-429-2258
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist