MEDICARE: DEBBIE JO LEWIS

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	7-4500	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2072967	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487704706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBBIE JO LEWIS

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	:	OWNER
Name	:	DEBBIE LEWIS
Credential	:
Telephone Number	:	405-794-3565

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	11/10/2021

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Directions to “DEBBIE JO LEWIS ” Practice Location

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