Provider Demographics
NPI:1891039533
Name:LEWIS, MOLLY MIX (RPH)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MIX
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 ST GEORGE RD
Mailing Address - Street 2:CVS
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7432
Mailing Address - Country:US
Mailing Address - Phone:802-872-8840
Mailing Address - Fax:802-872-8841
Practice Address - Street 1:2466 ST GEORGE RD
Practice Address - Street 2:CVS
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7432
Practice Address - Country:US
Practice Address - Phone:802-872-8840
Practice Address - Fax:802-872-8841
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330052936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist