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NPI Code Detail

MEDICARE: DR. LACEY GILDE PHARM D.

MEDICARE:  DR. LACEY  GILDE  PHARM D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302039077MI

General Provider Information

NPI Number : 1770910457
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LACEY GILDE PHARM D.
Provider Business Mailing Address
First Line : 1015 E PICKARD ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-1062
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1015 E PICKARD ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-1062
Country : US
Telephone Number : 989-775-2133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2013
Last Update Date : 04/30/2014

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Directions to “ DR. LACEY GILDE PHARM D.” Practice Location

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