Healthcare Provider Details

I. General information

NPI: 1699204560
Provider Name (Legal Business Name): CHRISTOPHER LEE LACEY PHARM.D. B.S. B.M.E.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 E COLONIAL DR
ORLANDO FL
32803-5245
US

IV. Provider business mailing address

11772 OXFORD ST
SEMINOLE FL
33772-6512
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-4427
  • Fax:
Mailing address:
  • Phone: 727-455-5154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS54720
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS54720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: