Provider Demographics
NPI:1710618053
Name:LEWIS, EDDIE EARL III (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:EARL
Last Name:LEWIS
Suffix:III
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 1:2724 GENERAL MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-8110
Mailing Address - Country:US
Mailing Address - Phone:337-309-5380
Mailing Address - Fax:
Practice Address - Street 1:105 N CITIES SERVICE HWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5419
Practice Address - Country:US
Practice Address - Phone:337-533-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69969183500000X
FLPS62097183500000X
LAPST.023821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist