Healthcare Provider Details

I. General information

NPI: 1497755730
Provider Name (Legal Business Name): JED STEVEN LEWIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMANCIPATION DR HAMPTON VA MEDICAL CENTER
HAMPTON VA
23667-0001
US

IV. Provider business mailing address

4936 BURNLEY DR
WILLIAMSBURG VA
23188-8802
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax:
Mailing address:
  • Phone: 757-259-0685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202006397
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: