Provider Demographics
NPI:1073835153
Name:LEWIS, JOHN A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
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 1:802 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1659
Mailing Address - Country:US
Mailing Address - Phone:269-948-9411
Mailing Address - Fax:269-948-0356
Practice Address - Street 1:802 W STATE ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1659
Practice Address - Country:US
Practice Address - Phone:269-948-9411
Practice Address - Fax:269-948-0356
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020269361835P0018X
AZ81171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist