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NPI Code Detail

MEDICARE: DR. LACEY KINCHELOE PHARM. D.

MEDICARE: DR. LACEY KINCHELOE PHARM. D.
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
1183500000XPharmacistRPH029185GA

General Provider Information

NPI Number : 1497343867
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LACEY KINCHELOE PHARM. D.
Provider Business Mailing Address
First Line : 220 BILL KENNEDY WAY SE APT A-135
Second Line :
City : ATLANTA
State : GA
Zip : 30316-7214
Country : US
Telephone Number : 404-272-4408
Fax Number : 401-652-0181
Provider Business Practice Location Address
First Line : 1035 LOWER FAYETTEVILLE RD
Second Line :
City : NEWNAN
State : GA
Zip : 30265-1132
Country : US
Telephone Number : 404-272-4408
Fax Number : 401-652-0181
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/01/2021
Last Update Date : 01/01/2021

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Directions to “ DR. LACEY KINCHELOE PHARM. D.” Practice Location

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