Healthcare Provider Details

I. General information

NPI: 1083234561
Provider Name (Legal Business Name): STEVEN ANTHONY LEWIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 32ND AVE S
GRAND FORKS ND
58201-6658
US

IV. Provider business mailing address

1950 32ND AVE S
GRAND FORKS ND
58201-6658
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-8643
  • Fax:
Mailing address:
  • Phone: 701-746-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH5960
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: