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General NPI Number Information
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NPI Number | 1619570314
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Entity Type | Individual
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Provider Name | NICOLE E LEWIS PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 204 S BELLEVUE AVE
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City | DOVER
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State | OH
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Zip | 44622-9405
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Country | US
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Telephone | 330-365-1085
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Fax | 330-756-1080
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Provider Business Mailing Address
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Address Line | 7292 FULTON DR NW
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City | CANTON
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State | OH
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Zip | 44718-1525
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3432011
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License Number State | OH
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