Provider Demographics
NPI:1063017960
Name:LEWIS, CLAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
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 1:3095 OLD ATLANTA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-2737
Mailing Address - Country:US
Mailing Address - Phone:770-844-5686
Mailing Address - Fax:770-844-5842
Practice Address - Street 1:3095 OLD ATLANTA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2737
Practice Address - Country:US
Practice Address - Phone:770-844-5686
Practice Address - Fax:770-844-5842
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist