Provider Demographics
NPI:1336431485
Name:LEWIS, AVIANCE SHAUNTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AVIANCE
Middle Name:SHAUNTE
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 1:7386 HARBOUR TOWNE PKWY
Mailing Address - Street 2:SUITE 21
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3463
Mailing Address - Country:US
Mailing Address - Phone:757-483-4129
Mailing Address - Fax:757-483-4240
Practice Address - Street 1:7386 HARBOUR TOWNE PKWY
Practice Address - Street 2:SUITE 21
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3463
Practice Address - Country:US
Practice Address - Phone:757-483-4129
Practice Address - Fax:757-483-4240
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist