Provider Demographics
NPI:1265899496
Name:LEWIS, MONIQUE RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:MONIQUE
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 1:10530 JOHN W ELLIOTT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-2013
Mailing Address - Country:US
Mailing Address - Phone:214-387-3753
Mailing Address - Fax:214-387-3796
Practice Address - Street 1:10530 JOHN W ELLIOTT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-2013
Practice Address - Country:US
Practice Address - Phone:214-387-3753
Practice Address - Fax:214-387-3796
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37326183500000X
LA018993183500000X
MS12384183500000X
VA0202214535183500000X
MI5302044227183500000X
ARPD13125183500000X
PARP450104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist