Provider Demographics
NPI:1538282967
Name:IVES, LEWIS JAMES III (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:JAMES
Last Name:IVES
Suffix:III
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 1:975 FAIRMONT W E
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701
Mailing Address - Country:US
Mailing Address - Phone:716-488-0640
Mailing Address - Fax:716-483-6590
Practice Address - Street 1:975 FAIRMONT W E
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-488-0640
Practice Address - Fax:716-483-6590
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist