Provider Demographics
NPI:1265770549
Name:LEWIS, ANGIE LYNN (BS)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 HYPOLUXO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5203
Mailing Address - Country:US
Mailing Address - Phone:561-304-1402
Mailing Address - Fax:561-304-1625
Practice Address - Street 1:8899 HYPOLUXO RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5203
Practice Address - Country:US
Practice Address - Phone:561-304-1402
Practice Address - Fax:561-304-1625
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist