Healthcare Provider Details

I. General information

NPI: 1386757839
Provider Name (Legal Business Name): ROGER LEWIS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N 4TH ST
TORONTO OH
43964-1510
US

IV. Provider business mailing address

519 N RIVER AVE
TORONTO OH
43964-1541
US

V. Phone/Fax

Practice location:
  • Phone: 740-537-2100
  • Fax: 740-537-1187
Mailing address:
  • Phone: 740-537-5341
  • Fax: 740-537-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-15455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: