Provider Demographics
NPI:1578836045
Name:LEWIS, MARY M (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5391 VITAE SPRINGS RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9707
Mailing Address - Country:US
Mailing Address - Phone:503-910-0544
Mailing Address - Fax:
Practice Address - Street 1:220 S SENECA RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2725
Practice Address - Country:US
Practice Address - Phone:541-344-0681
Practice Address - Fax:541-345-0264
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist