Provider Demographics
NPI:1649865635
Name:LEWIS, PAM ANNE (RPH)
Entity type:Individual
Prefix:
First Name:PAM
Middle Name:ANNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 COUNTY ROAD 327
Mailing Address - Street 2:
Mailing Address - City:BIG CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:38914-2622
Mailing Address - Country:US
Mailing Address - Phone:662-645-2331
Mailing Address - Fax:662-628-4590
Practice Address - Street 1:350 SUNSET DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4613
Practice Address - Country:US
Practice Address - Phone:662-417-8660
Practice Address - Fax:662-307-2750
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE060133336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy