Basic Information
| Provider Information | |||||||||
| NPI: | 1093792665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEW | ||||||||
| FirstName: | VERNON | ||||||||
| MiddleName: | THEODORE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 LISER GLN | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782571377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104818442 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2200 BERGQUIST DR | ||||||||
| Address2: | BLDG 8410 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782369907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102928418 | ||||||||
| FaxNumber: | 2102927207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 09/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835N1003X | 24525 | TX | Y | Pharmacy Service Providers | Pharmacist | Nutrition Support |
No ID Information.