Provider Demographics
NPI:1952850190
Name:LEWIS, TIMOTHY MARCUS
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARCUS
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2496
Mailing Address - Country:US
Mailing Address - Phone:205-631-8731
Mailing Address - Fax:
Practice Address - Street 1:1318 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2496
Practice Address - Country:US
Practice Address - Phone:205-631-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist