Healthcare Provider Details

I. General information

NPI: 1104927805
Provider Name (Legal Business Name): CHRISTOPHER S LACEY PHARM.D. BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-231-3291
Mailing address:
  • Phone: 216-791-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP044870L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP044870L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: