Provider Demographics
NPI:1982004594
Name:LEWIS, LAKEN
Entity Type:Individual
Prefix:
First Name:LAKEN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-9041
Mailing Address - Country:US
Mailing Address - Phone:337-392-3815
Mailing Address - Fax:337-392-3890
Practice Address - Street 1:3353 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-9041
Practice Address - Country:US
Practice Address - Phone:337-392-3815
Practice Address - Fax:337-392-3890
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.0211081835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Single Specialty