Provider Demographics
NPI:1659624575
Name:LEWIS, NANCY M (MS, RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2942
Mailing Address - Country:US
Mailing Address - Phone:505-342-7148
Mailing Address - Fax:
Practice Address - Street 1:1420 RENAISSANCE BLVD.
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-342-7148
Practice Address - Fax:505-342-7166
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist