Provider Demographics
NPI:1225324809
Name:LEWTER, MELISSA RENEE
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENEE
Last Name:LEWTER
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 1:4570 FRONTAGE RD NW
Mailing Address - Street 2:TARGET PHARMACY T-2367
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2905
Mailing Address - Country:US
Mailing Address - Phone:423-790-3001
Mailing Address - Fax:423-790-3001
Practice Address - Street 1:4570 FRONTAGE RD NW
Practice Address - Street 2:TARGET PHARMACY T-2367
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2905
Practice Address - Country:US
Practice Address - Phone:423-790-3001
Practice Address - Fax:423-790-3001
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist