Provider Demographics
NPI:1730480146
Name:LEWIS, KANDACE MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KANDACE
Middle Name:MICHELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KANDACE
Other - Middle Name:MICHELLE
Other - Last Name:BARRE'
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8120 S COCKRELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75236-9668
Mailing Address - Country:US
Mailing Address - Phone:972-283-1473
Mailing Address - Fax:
Practice Address - Street 1:8120 S COCKRELL HILL RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75236-9668
Practice Address - Country:US
Practice Address - Phone:972-283-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49129183500000X
LA019234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist