Provider Demographics
NPI:1043600950
Name:LEWIS, BRIAN ERVIN (PHARMD, MBA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ERVIN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 PENN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2100
Mailing Address - Country:US
Mailing Address - Phone:610-376-3000
Mailing Address - Fax:610-478-3000
Practice Address - Street 1:1235 PENN AVE STE 101
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2100
Practice Address - Country:US
Practice Address - Phone:610-376-3000
Practice Address - Fax:610-478-3000
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO3967500183500000X
KY021176183500000X
VA0202218463183500000X
LAPST.023323183500000X
MD26993183500000X
WVRP0011985183500000X
NJ28RW00241400183700000X
PARP453172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician