=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881805364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET MCLEAN, LACEY HYDE PHARM.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1306 N CENTRAL AVE
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54449-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-387-3705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 3RD ST S
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54494-4725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14594 - 040
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------