Provider Demographics
NPI:1700984259
Name:LEW, TIMOTHY JON (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JON
Last Name:LEW
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 KING LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4919
Mailing Address - Country:US
Mailing Address - Phone:210-614-6880
Mailing Address - Fax:
Practice Address - Street 1:3600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5768
Practice Address - Country:US
Practice Address - Phone:830-792-2422
Practice Address - Fax:830-792-2499
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist