Provider Demographics
NPI:1316227804
Name:LEWIS, TERRY LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LOUISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8959
Mailing Address - Country:US
Mailing Address - Phone:219-462-7962
Mailing Address - Fax:219-465-5735
Practice Address - Street 1:6030 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3501
Practice Address - Country:US
Practice Address - Phone:219-762-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014508A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist