Provider Demographics
NPI:1366857880
Name:LEWIS, PAMELA (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-9095
Mailing Address - Country:US
Mailing Address - Phone:318-428-9641
Mailing Address - Fax:318-428-9277
Practice Address - Street 1:705 S CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-9095
Practice Address - Country:US
Practice Address - Phone:318-428-9641
Practice Address - Fax:318-428-9277
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist