Provider Demographics
NPI:1972834844
Name:LEWIS, JAMES CLARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLARK
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2491 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6153
Mailing Address - Country:US
Mailing Address - Phone:928-341-0589
Mailing Address - Fax:928-341-0611
Practice Address - Street 1:2491 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6153
Practice Address - Country:US
Practice Address - Phone:928-341-0589
Practice Address - Fax:928-341-0611
Is Sole Proprietor?:No
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3920325780OtherDRIVERS LICENSE