Healthcare Provider Details

I. General information

NPI: 1063690220
Provider Name (Legal Business Name): CAROLINE CLENDENIN LEWIS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2008
Last Update Date: 02/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 FRIENDLY CENTER RD STE C
GREENSBORO NC
27408-2024
US

IV. Provider business mailing address

205B MALLARD CREEK DR
GRAHAM NC
27253-8457
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-6888
  • Fax:
Mailing address:
  • Phone: 910-603-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18959
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: