Provider Demographics
NPI:1174173470
Name:SASSER, LEWIS ELWOOD III
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:ELWOOD
Last Name:SASSER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1724
Mailing Address - Country:US
Mailing Address - Phone:919-739-5539
Mailing Address - Fax:
Practice Address - Street 1:4003 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-9674
Practice Address - Country:US
Practice Address - Phone:252-559-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist