Provider Demographics
NPI:1417164047
Name:LEW, SHANNON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:LEW
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W ORANGE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3170
Mailing Address - Country:US
Mailing Address - Phone:714-220-0719
Mailing Address - Fax:714-220-3180
Practice Address - Street 1:3010 W ORANGE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3170
Practice Address - Country:US
Practice Address - Phone:714-220-0719
Practice Address - Fax:714-220-3180
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 43585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist