Provider Demographics
NPI:1114296266
Name:LEWIS, CHERIA
Entity Type:Individual
Prefix:
First Name:CHERIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2505
Mailing Address - Country:US
Mailing Address - Phone:954-430-9510
Mailing Address - Fax:954-430-9345
Practice Address - Street 1:12400 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2505
Practice Address - Country:US
Practice Address - Phone:954-430-9510
Practice Address - Fax:954-430-9345
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist