MEDICARE: MARIA L LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH04812	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH04812	OTHER	RI	RPH 04812

General Provider Information

NPI Number	:	1023733615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA L LEWIS

Provider Business Mailing Address
First Line	:	2125 DIAMOND HILL RD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-5134
Country	:	US
Telephone Number	:	781-844-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 DIAMOND HILL RD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-5134
Country	:	US
Telephone Number	:	401-335-4563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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