MEDICARE: DR. JED STEVEN LEWIS PHARMD

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	1835P1200X	Pharmacotherapy Pharmacist	0202006397	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0202006397	OTHER	VA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1497755730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JED STEVEN LEWIS PHARMD

Provider Business Mailing Address
First Line	:	4936 BURNLEY DR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-8802
Country	:	US
Telephone Number	:	757-259-0685
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 EMANCIPATION DR
Second Line	:	HAMPTON VA MEDICAL CENTER
City	:	HAMPTON
State	:	VA
Zip	:	23667-0001
Country	:	US
Telephone Number	:	757-722-9961
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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