Provider Demographics
NPI:1669727939
Name:LEWALLEN, ATHENA L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:L
Last Name:LEWALLEN
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 1:601 N SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-2104
Mailing Address - Country:US
Mailing Address - Phone:501-354-4669
Mailing Address - Fax:
Practice Address - Street 1:505 SALEM RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4815
Practice Address - Country:US
Practice Address - Phone:501-328-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist