Healthcare Provider Details

I. General information

NPI: 1396651329
Provider Name (Legal Business Name): LACIE MCMANAWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 E JOHN ROWAN BLVD
BARDSTOWN KY
40004-3214
US

IV. Provider business mailing address

642 CECILIA SMITH MILL RD
CECILIA KY
42724-9653
US

V. Phone/Fax

Practice location:
  • Phone: 502-349-6044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number026014
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: