Provider Demographics
NPI:1093792665
Name:LEW, VERNON THEODORE (RPH)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:THEODORE
Last Name:LEW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:8 LISER GLN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1377
Mailing Address - Country:US
Mailing Address - Phone:210-481-8442
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:BLDG 8410
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-292-8418
Practice Address - Fax:210-292-7207
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX245251835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support