Provider Demographics
NPI:1740806496
Name:LEWIS, JEFF (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 KELSEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4504
Mailing Address - Country:US
Mailing Address - Phone:330-607-2052
Mailing Address - Fax:
Practice Address - Street 1:378 KELSEY PARK DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4504
Practice Address - Country:US
Practice Address - Phone:330-607-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist