Provider Demographics
NPI:1477877801
Name:LEWIS, REGINALD SCOTT (RPH)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:SCOTT
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11923 COUNTY ROAD 140
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-5017
Mailing Address - Country:US
Mailing Address - Phone:903-343-5636
Mailing Address - Fax:
Practice Address - Street 1:11923 COUNTY ROAD 140
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-5017
Practice Address - Country:US
Practice Address - Phone:903-343-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-13
Last Update Date:2010-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist