Provider Demographics
NPI:1356501720
Name:LEWIS, RODNEY ALLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ALLEN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7289 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32442-3776
Mailing Address - Country:US
Mailing Address - Phone:850-592-8481
Mailing Address - Fax:
Practice Address - Street 1:7995 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:SNEADS
Practice Address - State:FL
Practice Address - Zip Code:32460-2308
Practice Address - Country:US
Practice Address - Phone:850-593-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS179871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist