Provider Demographics
NPI:1952921991
Name:LEWIS, CARL P
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:P
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NATION'S MEDICINES
Mailing Address - Street 2:3000 ALVEY PARK DRIVE WEST
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-926-4080
Mailing Address - Fax:
Practice Address - Street 1:NATION'S MEDICINES
Practice Address - Street 2:3000 ALVEY PARK DRIVE WEST
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-926-4080
Practice Address - Fax:270-684-4407
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist