Provider Demographics
NPI:1245713270
Name:LEWIS, KATELYN PATRICIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:PATRICIA
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 1:841 GEORGES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3359
Mailing Address - Country:US
Mailing Address - Phone:732-545-9487
Mailing Address - Fax:
Practice Address - Street 1:841 GEORGES RD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3359
Practice Address - Country:US
Practice Address - Phone:732-545-9487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI3957300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RJ07810OtherIMMUNIZATION APPROVAL
NJ28RI03957300OtherPHARMACIST