Provider Demographics
NPI:1609052562
Name:LEWYCKYJ, PAULA J
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:LEWYCKYJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7194 HERTFORDSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1171
Mailing Address - Country:US
Mailing Address - Phone:585-305-2269
Mailing Address - Fax:
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1432
Practice Address - Country:US
Practice Address - Phone:585-678-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist