Provider Demographics
NPI:1134366800
Name:GAUTHIER-LEWIS, MARY LYNN
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNN
Last Name:GAUTHIER-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3849 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3854
Mailing Address - Country:US
Mailing Address - Phone:225-219-9680
Mailing Address - Fax:225-219-9813
Practice Address - Street 1:5825 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-2408
Practice Address - Country:US
Practice Address - Phone:225-358-1415
Practice Address - Fax:225-358-1158
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA165231835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist