Individual
BETSY JO LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 JUNIPER AVE, WADENA, MN 56482-1041
(218) 849-6414
Mailing address
100 JUNIPER AVE, WADENA, MN 56482-1041
(218) 849-6414
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
122329
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122329
LICENSE NUMBER
MN
Enumeration date
10/13/2020
Last updated
10/13/2020
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