Provider Demographics
NPI:1700167202
Name:LEWIS, CATINA WANE
Entity Type:Individual
Prefix:MRS
First Name:CATINA
Middle Name:WANE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 TRI CITY DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6324
Mailing Address - Country:US
Mailing Address - Phone:405-387-5006
Mailing Address - Fax:
Practice Address - Street 1:3232 TRI CITY DR
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6324
Practice Address - Country:US
Practice Address - Phone:405-387-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist