MEDICARE: MISS DEBBIE JO LEWIS DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11397	OK

General Provider Information

NPI Number	:	1114016359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DEBBIE JO LEWIS DPH

Provider Business Mailing Address
First Line	:	322 N SERVICE RD
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-4945
Country	:	US
Telephone Number	:	405-794-3565
Fax Number	:	405-794-0112

Provider Business Practice Location Address
First Line	:	322 N SERVICE RD
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-4945
Country	:	US
Telephone Number	:	405-794-3565
Fax Number	:	405-794-0112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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