Provider Demographics
NPI:1679188445
Name:LEWIS, MONICA LEE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 US HIGHWAY 380
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2087
Mailing Address - Country:US
Mailing Address - Phone:940-683-1510
Mailing Address - Fax:
Practice Address - Street 1:1203 US HIGHWAY 380
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2087
Practice Address - Country:US
Practice Address - Phone:940-683-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist