Provider Demographics
NPI:1235756438
Name:LEWIS, MARCIA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-2639
Mailing Address - Country:US
Mailing Address - Phone:586-755-3046
Mailing Address - Fax:586-755-4348
Practice Address - Street 1:1843 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-2639
Practice Address - Country:US
Practice Address - Phone:586-755-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist