Provider Demographics
NPI:1659694222
Name:LEWIS, LIANE J (RPH)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:J
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 1:233 5TH AVE EXT
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1814
Mailing Address - Country:US
Mailing Address - Phone:518-773-8577
Mailing Address - Fax:518-773-8577
Practice Address - Street 1:233 5TH AVE EXT
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1814
Practice Address - Country:US
Practice Address - Phone:518-773-8577
Practice Address - Fax:518-773-8577
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037416-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist