MEDICARE: LEWIS KIVETT PHARMD, RPH

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	26025227A	IN

General Provider Information

NPI Number	:	1447676135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEWIS KIVETT PHARMD, RPH

Provider Business Mailing Address
First Line	:	700 RESERVE BLVD APT 200
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-9155
Country	:	US
Telephone Number	:	812-480-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 E MORGAN AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47711-4308
Country	:	US
Telephone Number	:	812-425-4422
Fax Number	:

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

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	03/05/2014

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