Provider Demographics
NPI:1265753651
Name:PATRICK, LEWIS STEVENSON (RPH)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:STEVENSON
Last Name:PATRICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VICKERS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1430
Mailing Address - Country:US
Mailing Address - Phone:856-451-9025
Mailing Address - Fax:
Practice Address - Street 1:1070 N PEARL ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1215
Practice Address - Country:US
Practice Address - Phone:856-455-7020
Practice Address - Fax:856-455-7150
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01431100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist