Provider Demographics
NPI:1912248311
Name:LEWIS, ROGER HELM (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:HELM
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 STONEGATE WAY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4831
Mailing Address - Country:US
Mailing Address - Phone:361-852-6806
Mailing Address - Fax:361-857-0052
Practice Address - Street 1:5440 STONEGATE WAY
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4831
Practice Address - Country:US
Practice Address - Phone:361-852-6806
Practice Address - Fax:361-857-0052
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist