Provider Demographics
NPI:1447556469
Name:LEWIS FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:LEWIS FAMILY PHARMACY INC
Other - Org Name:SPECIALTY MEDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, AO, TECH
Authorized Official - Prefix:
Authorized Official - First Name:HAMZIEH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-281-3636
Mailing Address - Street 1:29930 W 12 MILE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3983
Mailing Address - Country:US
Mailing Address - Phone:248-281-3636
Mailing Address - Fax:248-281-3635
Practice Address - Street 1:29930 W 12 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3983
Practice Address - Country:US
Practice Address - Phone:248-281-3636
Practice Address - Fax:248-281-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0002X, 3336M0003X
MI53010110883336C0003X
MI53010095293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144332OtherPK