=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366042889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY LEWIS PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2020
-----------------------------------------------------
Last Update Date | 10/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 WALDON DR
-----------------------------------------------------
City | HARLAN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40831-2535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-573-9650
-----------------------------------------------------
Fax | 606-573-7101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 WALDON DR
-----------------------------------------------------
City | HARLAN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40831-2535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-573-9650
-----------------------------------------------------
Fax | 606-573-7101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 015015
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------