Provider Demographics
NPI:1902179823
Name:LEWIS, JASON DWIGHT (PHARMD, RPH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DWIGHT
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 1:1009 COOKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6073
Mailing Address - Country:US
Mailing Address - Phone:919-604-1662
Mailing Address - Fax:
Practice Address - Street 1:2900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1921
Practice Address - Country:US
Practice Address - Phone:252-823-5655
Practice Address - Fax:252-823-0412
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC17246OtherBOARD OF PHARMACY LICENSE