Provider Demographics
NPI:1518177955
Name:LEWIS-NABORS, MARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:LEWIS-NABORS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 STUBBS VINSON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8582
Mailing Address - Country:US
Mailing Address - Phone:318-343-8456
Mailing Address - Fax:
Practice Address - Street 1:6198 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-9010
Practice Address - Country:US
Practice Address - Phone:318-397-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist