Healthcare Provider Details

I. General information

NPI: 1710084652
Provider Name (Legal Business Name): LEWISVILLE DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 SHALLOWFORD RD
LEWISVILLE NC
27023-9847
US

IV. Provider business mailing address

6715 SHALLOWFORD RD
LEWISVILLE NC
27023-9847
US

V. Phone/Fax

Practice location:
  • Phone: 336-946-0220
  • Fax: 336-946-0199
Mailing address:
  • Phone: 336-946-0220
  • Fax: 336-946-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09019
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH ALAN VANCE
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 336-946-0220