Provider Demographics
NPI:1962797316
Name:LEWANDOWSKI, MARK THOMAS (R PH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 E US HIGHWAY 30
Mailing Address - Street 2:T-0870
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5898
Mailing Address - Country:US
Mailing Address - Phone:219-942-1267
Mailing Address - Fax:
Practice Address - Street 1:2661 E US HIGHWAY 30
Practice Address - Street 2:T-0870
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5898
Practice Address - Country:US
Practice Address - Phone:219-942-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014341A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist