Provider Demographics
NPI:1821378738
Name:LEWIS, JATHIYAH AMEERAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:JATHIYAH
Middle Name:AMEERAH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W CLEVELAND DR UPPR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1816
Mailing Address - Country:US
Mailing Address - Phone:716-715-8853
Mailing Address - Fax:
Practice Address - Street 1:1556 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2806
Practice Address - Country:US
Practice Address - Phone:716-834-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20055912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist