Healthcare Provider Details

I. General information

NPI: 1962797316
Provider Name (Legal Business Name): MARK THOMAS LEWANDOWSKI R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2661 E US HIGHWAY 30 T-0870
MERRILLVILLE IN
46410-5898
US

IV. Provider business mailing address

2661 E US HIGHWAY 30 T-0870
MERRILLVILLE IN
46410-5898
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-1267
  • Fax:
Mailing address:
  • Phone: 219-942-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26014341A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: