Provider Demographics
NPI:1265920201
Name:LEWIS, KIMBERLY DEVORE (PHARM D)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DEVORE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 WALDEN WOODS CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-5673
Mailing Address - Country:US
Mailing Address - Phone:901-734-4360
Mailing Address - Fax:901-765-6464
Practice Address - Street 1:560 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2504
Practice Address - Country:US
Practice Address - Phone:901-734-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist