Healthcare Provider Details

I. General information

NPI: 1871876896
Provider Name (Legal Business Name): KAREN DONETTA LEWIS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5864 FAIRBURN RD
DOUGLASVILLE GA
30134-2301
US

IV. Provider business mailing address

2240 DEFOORS FERRY RD NW
ATLANTA GA
30318-2324
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-9307
  • Fax: 770-949-9633
Mailing address:
  • Phone: 678-429-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH021452
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: