Provider Demographics
NPI:1073257861
Name:LEWIS, CRYSTAL PADA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:PADA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W 13TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4069
Mailing Address - Country:US
Mailing Address - Phone:253-777-8955
Mailing Address - Fax:
Practice Address - Street 1:11 GRANT RD
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5328
Practice Address - Country:US
Practice Address - Phone:509-881-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60875973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist