MEDICARE: MR. DENNIS RAY LEWIS R.PH.

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	3407	WV

General Provider Information

NPI Number	:	1609834092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS RAY LEWIS R.PH.

Provider Business Mailing Address
First Line	:	84 HIDDEN VLY
Second Line	:
City	:	CHAPMANVILLE
State	:	WV
Zip	:	25508-9501
Country	:	US
Telephone Number	:	304-855-4764
Fax Number	:	304-831-6001

Provider Business Practice Location Address
First Line	:	3316 S MAIN STREET
Second Line	:
City	:	CHAPMANVILLE
State	:	WV
Zip	:	25508
Country	:	US
Telephone Number	:	304-855-4764
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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