Provider Demographics
NPI:1639715469
Name:LEWANDOWSKI, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:LEWANDOWSKI
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 1:64660 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065
Mailing Address - Country:US
Mailing Address - Phone:586-540-8004
Mailing Address - Fax:586-540-8005
Practice Address - Street 1:64660 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065
Practice Address - Country:US
Practice Address - Phone:586-540-8004
Practice Address - Fax:586-540-8005
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028150183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist