MEDICARE: DR. BRETT WILLIAM LACY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	57606	TX

General Provider Information

NPI Number	:	1003419201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT WILLIAM LACY PHARMD

Provider Business Mailing Address
First Line	:	1547 MCKINLEY AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-4346
Country	:	US
Telephone Number	:	184-752-9476
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 E SOUTHCROSS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1903
Country	:	US
Telephone Number	:	210-532-3923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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