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NPI Code Detail

MEDICARE: DR. LACEY JEAN WALDROOP KOCIAN PHARM.D., RPH

MEDICARE: DR. LACEY JEAN WALDROOP KOCIAN PHARM.D., RPH
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
1183500000XPharmacistRPH-0016788OR

General Provider Information

NPI Number : 1124598446
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LACEY JEAN WALDROOP KOCIAN PHARM.D., RPH
Provider Business Mailing Address
First Line : 1750 WILLOW CREEK CIR
Second Line :
City : EUGENE
State : OR
Zip : 97402-9152
Country : US
Telephone Number : 541-744-1641
Fax Number : 541-744-1052
Provider Business Practice Location Address
First Line : 1750 WILLOW CREEK CIR
Second Line :
City : EUGENE
State : OR
Zip : 97402-9152
Country : US
Telephone Number : 541-744-1641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2018
Last Update Date : 11/29/2018

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