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General NPI Number Information
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NPI Number | 1811583008
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Entity Type | Individual
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Provider Name | CARLA L LACY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/12/2020
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Last Update Date | 12/12/2020
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Provider Practice Location Address
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Address Line | 5601 NW 72ND ST STE 242
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City | WARR ACRES
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State | OK
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Zip | 73132-5923
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Country | US
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Telephone | 888-773-8267
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Fax |
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Provider Business Mailing Address
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Address Line | 341356 E COUNTRY MEADOWS DR
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City | MEEKER
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State | OK
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Zip | 74855-5006
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Country | US
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Telephone | 405-519-0005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14438
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License Number State | OK
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