Provider Demographics
NPI:1346970316
Name:LEWIS, AMARI JAMIONE
Entity Type:Individual
Prefix:
First Name:AMARI
Middle Name:JAMIONE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMARI
Other - Middle Name:JAMIONE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:249 CHAMPIONS WAY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7549
Mailing Address - Country:US
Mailing Address - Phone:863-258-3309
Mailing Address - Fax:
Practice Address - Street 1:249 CHAMPIONS WAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7549
Practice Address - Country:US
Practice Address - Phone:863-258-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93005953183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL200-010-99-822-0Medicaid