Provider Demographics
NPI:1033391032
Name:LEWIS, ETHEL MAE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:MAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 COLUMBIA AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4315
Mailing Address - Country:US
Mailing Address - Phone:425-605-0497
Mailing Address - Fax:
Practice Address - Street 1:1090 COLUMBIA AVE APT 104
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4315
Practice Address - Country:US
Practice Address - Phone:425-605-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00057456183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician