Healthcare Provider Details

I. General information

NPI: 1972824977
Provider Name (Legal Business Name): JELENA LEWIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD STE 601
BEVERLY HILLS CA
90211-1793
US

IV. Provider business mailing address

6060 BUCKINGHAM PKWY APT 406
CULVER CITY CA
90230-6826
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3534
  • Fax:
Mailing address:
  • Phone: 310-621-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: