Provider Demographics
NPI:1790093979
Name:LEWIS, CYNTHIA AUDREY
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:AUDREY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HIGHWAY 641 N
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1378
Mailing Address - Country:US
Mailing Address - Phone:731-584-7595
Mailing Address - Fax:731-584-0779
Practice Address - Street 1:195 HIGHWAY 641 N
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1378
Practice Address - Country:US
Practice Address - Phone:731-584-7595
Practice Address - Fax:731-584-0779
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist