Provider Demographics
NPI:1689039497
Name:LEWIS-JOHNSON, ANDREA (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:LEWIS-JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:LEWIS-JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3836 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5802
Mailing Address - Country:US
Mailing Address - Phone:832-325-5859
Mailing Address - Fax:832-325-5856
Practice Address - Street 1:3836 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5802
Practice Address - Country:US
Practice Address - Phone:832-325-5859
Practice Address - Fax:832-325-5856
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003064106OtherNPI