Provider Demographics
NPI:1093126831
Name:LEW, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39200 PASEO PADRE PKWY
Mailing Address - Street 2:RALEYS PHARMACY
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1616
Mailing Address - Country:US
Mailing Address - Phone:510-791-0657
Mailing Address - Fax:510-791-2673
Practice Address - Street 1:39200 PASEO PADRE PKWY
Practice Address - Street 2:RALEYS PHARMACY
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1616
Practice Address - Country:US
Practice Address - Phone:510-791-0657
Practice Address - Fax:510-791-2673
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist