Provider Demographics
NPI:1982393377
Name:LEWIS, ANTHONY FREDRICK
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FREDRICK
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 1:4432 OAKENGATES DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8892
Mailing Address - Country:US
Mailing Address - Phone:734-961-5172
Mailing Address - Fax:
Practice Address - Street 1:753 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6304
Practice Address - Country:US
Practice Address - Phone:734-482-7430
Practice Address - Fax:734-480-1353
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician