Provider Demographics
NPI:1164723078
Name:LEW, WILSON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:
Last Name:LEW
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 EAST BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2236
Mailing Address - Country:US
Mailing Address - Phone:909-451-1014
Mailing Address - Fax:909-451-1015
Practice Address - Street 1:2155 E. BASELINE RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2236
Practice Address - Country:US
Practice Address - Phone:909-451-1014
Practice Address - Fax:909-451-1015
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist