Provider Demographics
NPI:1003207408
Name:LEWIS, JOVON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOVON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BRUNE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1401
Mailing Address - Country:US
Mailing Address - Phone:443-904-7035
Mailing Address - Fax:
Practice Address - Street 1:3559 BOSTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5750
Practice Address - Country:US
Practice Address - Phone:410-246-8516
Practice Address - Fax:410-246-8526
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDEXPECTED 2015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist