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NPI Code Detail

MEDICARE: LACEY DRUG COMPANY, INC

MEDICARE: LACEY DRUG COMPANY, INC
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
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831273747
Entity Type Code : Organization
Provider Name (Legal Business Name) : LACEY DRUG COMPANY, INC
Provider Business Mailing Address
First Line : 4797 S MAIN ST
Second Line :
City : ACWORTH
State : GA
Zip : 30101-5339
Country : US
Telephone Number : 770-974-3131
Fax Number : 770-975-9735
Provider Business Practice Location Address
First Line : 4797 S MAIN ST
Second Line :
City : ACWORTH
State : GA
Zip : 30101-5339
Country : US
Telephone Number : 770-974-3131
Fax Number : 770-975-9735
Authorized Official
Title or Position : DME MANAGER
Name : MS. CAROL JERAULD
Credential :
Telephone Number : 770-974-3131
Provider Enumeration Date : 10/25/2006
Last Update Date : 11/07/2008

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Directions to “LACEY DRUG COMPANY, INC ” Practice Location

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