Provider Demographics
NPI:1982712378
Name:LEWIS, VIRGENA A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:VIRGENA
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:2200 BERQUIST DRIVE
Mailing Address - Street 2:LACKLAND AIR FORCE BASE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78236-0000
Mailing Address - Country:US
Mailing Address - Phone:210-292-8409
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-0000
Practice Address - Country:US
Practice Address - Phone:210-292-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist