Provider Demographics
NPI:1447036579
Name:LEWIS, CARLY LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MEADOW RUN RD
Mailing Address - Street 2:
Mailing Address - City:BEAR CREEK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18702-9304
Mailing Address - Country:US
Mailing Address - Phone:570-406-9701
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist