Provider Demographics
NPI:1699954149
Name:LEWIS, GAIK
Entity type:Individual
Prefix:
First Name:GAIK
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:13736-2634
Mailing Address - Country:US
Mailing Address - Phone:607-657-2865
Mailing Address - Fax:
Practice Address - Street 1:201 CONKLIN AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-2147
Practice Address - Country:US
Practice Address - Phone:607-772-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00825181Medicaid