Healthcare Provider Details

I. General information

NPI: 1013560895
Provider Name (Legal Business Name): CLAY LEWIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11999 DALLAS PKWY
FRISCO TX
75033-4272
US

IV. Provider business mailing address

14651 CAMPBELL RD
OVERBROOK OK
73453-2224
US

V. Phone/Fax

Practice location:
  • Phone: 214-872-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: