Provider Demographics
NPI:1366042889
Name:LEWIS, TIMOTHY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WALDON DR
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2535
Mailing Address - Country:US
Mailing Address - Phone:606-573-9650
Mailing Address - Fax:606-573-7101
Practice Address - Street 1:201 WALDON DR
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2535
Practice Address - Country:US
Practice Address - Phone:606-573-9650
Practice Address - Fax:606-573-7101
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist