MEDICARE: MRS. MELISSA RENEE LEWTER

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	35886	TN

General Provider Information

NPI Number	:	1225324809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA RENEE LEWTER

Provider Business Mailing Address
First Line	:	4570 FRONTAGE RD NW
Second Line	:	TARGET PHARMACY T-2367
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2905
Country	:	US
Telephone Number	:	423-790-3001
Fax Number	:	423-790-3001

Provider Business Practice Location Address
First Line	:	4570 FRONTAGE RD NW
Second Line	:	TARGET PHARMACY T-2367
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2905
Country	:	US
Telephone Number	:	423-790-3001
Fax Number	:	423-790-3001

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	06/22/2011

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