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General NPI Number Information
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NPI Number | 1023123825
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Entity Type | Organization
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Legal Business Name | LACEY DRUG COMPANY INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 4469 LEMON ST
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City | ACWORTH
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State | GA
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Zip | 30101-5418
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Country | US
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Telephone | 678-236-0400
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Fax | 678-236-0404
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Provider Business Mailing Address
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Address Line | 4469 LEMON ST
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City | ACWORTH
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State | GA
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Zip | 30101-5418
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Country | US
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Telephone | 678-236-0400
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Fax | 678-236-0404
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Authorized Official
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Title or Position | V-P
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Name | BENNIE FLANAGAN
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Credential |
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Telephone | 678-236-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHRE008914
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License Number State | GA
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