MEDICARE: DR. DEMAR LEWIS III 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	37541	CA
2	1835N1003X	Nutrition Support Pharmacist	37541	CA
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	37541	CA

General Provider Information

NPI Number	:	1942500921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEMAR LEWIS III PHARMD

Provider Business Mailing Address
First Line	:	1024 S COLUMBINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4729
Country	:	US
Telephone Number	:	303-578-0499
Fax Number	:	866-457-6729

Provider Business Practice Location Address
First Line	:	1024 S COLUMBINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4729
Country	:	US
Telephone Number	:	303-578-0499
Fax Number	:	866-457-6729

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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