MEDICARE: BROOKE LEWIS PHARM D

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	E-13952	MS

General Provider Information

NPI Number	:	1689054868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE LEWIS PHARM D

Provider Business Mailing Address
First Line	:	401 E LEE ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1227
Country	:	US
Telephone Number	:	662-487-3101
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E LEE ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1227
Country	:	US
Telephone Number	:	662-487-3101
Fax Number	:

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

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	10/17/2018

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Directions to “ BROOKE LEWIS PHARM D” Practice Location

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