Provider Demographics
NPI:1801127766
Name:LEWIS, TERESA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
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 1:2801 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8125
Mailing Address - Country:US
Mailing Address - Phone:928-344-0453
Mailing Address - Fax:928-341-9527
Practice Address - Street 1:2801 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8125
Practice Address - Country:US
Practice Address - Phone:928-344-0453
Practice Address - Fax:928-341-9527
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3920308934OtherDRIVER LICENSE