Provider Demographics
NPI:1487878393
Name:LEWIS, EVERETT LEE JR (RPH)
Entity type:Individual
Prefix:MR
First Name:EVERETT
Middle Name:LEE
Last Name:LEWIS
Suffix:JR
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 1:111A N HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-1597
Mailing Address - Country:US
Mailing Address - Phone:704-922-3001
Mailing Address - Fax:704-922-0060
Practice Address - Street 1:111A N HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1597
Practice Address - Country:US
Practice Address - Phone:704-922-3001
Practice Address - Fax:704-922-0060
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6586OtherPHARMACIST LICENSE NUMBER