Provider Demographics
NPI:1386757839
Name:LEWIS, ROGER (RPH)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:LEWIS
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 1:519 N RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1541
Mailing Address - Country:US
Mailing Address - Phone:740-537-5341
Mailing Address - Fax:740-537-1187
Practice Address - Street 1:302 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1510
Practice Address - Country:US
Practice Address - Phone:740-537-2100
Practice Address - Fax:740-537-1187
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-15455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist