Provider Demographics
NPI:1023310851
Name:LEWIS, ANGELENE RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGELENE
Middle Name:RENEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5740
Mailing Address - Country:US
Mailing Address - Phone:804-288-4936
Mailing Address - Fax:804-288-2874
Practice Address - Street 1:1510 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5740
Practice Address - Country:US
Practice Address - Phone:804-288-4936
Practice Address - Fax:804-288-2874
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01011603Medicaid