Healthcare Provider Details

I. General information

NPI: 1982360020
Provider Name (Legal Business Name): TAYLOR WOLFE LEWIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MARTIN LUTHER KING JR DR
WASHINGTON NC
27889-4906
US

IV. Provider business mailing address

5430 CREECH RD
LUCAMA NC
27851-9102
US

V. Phone/Fax

Practice location:
  • Phone: 252-940-0602
  • Fax:
Mailing address:
  • Phone: 704-913-4715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26555
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: