Provider Demographics
NPI:1255605887
Name:LEWIS, PAUL KENNETH (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:KENNETH
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST UNIT 180
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5701
Mailing Address - Country:US
Mailing Address - Phone:502-813-6100
Mailing Address - Fax:502-813-6108
Practice Address - Street 1:401 E CHESTNUT ST UNIT 180
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5701
Practice Address - Country:US
Practice Address - Phone:502-813-6100
Practice Address - Fax:502-813-6108
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist