Healthcare Provider Details

I. General information

NPI: 1598678740
Provider Name (Legal Business Name): SAMUEL LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-6339
  • Fax:
Mailing address:
  • Phone: 850-766-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: