Provider Demographics
NPI:1407227523
Name:LEWIS, VIRGINIA W (PHARMD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:P
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6768 MONTERRA TRL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1343
Mailing Address - Country:US
Mailing Address - Phone:310-880-8277
Mailing Address - Fax:
Practice Address - Street 1:6768 MONTERRA TRL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1343
Practice Address - Country:US
Practice Address - Phone:310-880-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist