Healthcare Provider Details

I. General information

NPI: 1417523069
Provider Name (Legal Business Name): MARSHA LYNN LEWIS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W BROAD ST
RICHMOND VA
23220-4223
US

IV. Provider business mailing address

8705 BEACONTREE LN APT 5
HENRICO VA
23294-4718
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-1340
  • Fax: 804-225-8072
Mailing address:
  • Phone: 804-305-9859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230002382
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: