Provider Demographics
NPI:1700019890
Name:LEWIS, ROSS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 OLD SPARTANBURG HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792
Mailing Address - Country:US
Mailing Address - Phone:954-261-7733
Mailing Address - Fax:
Practice Address - Street 1:640 SPARTANBURG HIGHWAY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792
Practice Address - Country:US
Practice Address - Phone:828-692-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0455584Medicaid