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NPI Code Detail

MEDICARE: DR. GARY LEE LEWIS

MEDICARE:  DR. GARY LEE 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
1183500000XPharmacist05910AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105910OTHERARPHARMACIST LICENSE

General Provider Information

NPI Number : 1841286952
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY LEE LEWIS
Provider Business Mailing Address
First Line : 1941 NEVADA 23
Second Line :
City : PRESCOTT
State : AR
Zip : 71857-7008
Country : US
Telephone Number : 870-887-5857
Fax Number : 870-887-2113
Provider Business Practice Location Address
First Line : 1430 W 1ST ST N
Second Line :
City : PRESCOTT
State : AR
Zip : 71857-3339
Country : US
Telephone Number : 870-887-2717
Fax Number : 870-887-2113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 07/08/2007

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Directions to “ DR. GARY LEE LEWIS ” Practice Location

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