MEDICARE: MARA LEWIS-NABORS PHARMD.

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	16764	LA

General Provider Information

NPI Number	:	1518177955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA LEWIS-NABORS PHARMD.

Provider Business Mailing Address
First Line	:	529 STUBBS VINSON RD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-8582
Country	:	US
Telephone Number	:	318-343-8456
Fax Number	:

Provider Business Practice Location Address
First Line	:	6198 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-9010
Country	:	US
Telephone Number	:	318-397-5673
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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