Provider Demographics
NPI:1871876896
Name:LEWIS, KAREN DONETTA (PHARMD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DONETTA
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 1:2240 DEFOORS FERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2324
Mailing Address - Country:US
Mailing Address - Phone:678-429-8859
Mailing Address - Fax:
Practice Address - Street 1:5864 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2301
Practice Address - Country:US
Practice Address - Phone:770-949-9307
Practice Address - Fax:770-949-9633
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021452183500000X
CA48225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist