Healthcare Provider Details

I. General information

NPI: 1457287781
Provider Name (Legal Business Name): MAYA MARTI LACEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2451
US

IV. Provider business mailing address

3701 CONTI ST
NEW ORLEANS LA
70119-5275
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.025966
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: