# LACEY DRUG COMPANY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LACEYS LTC PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023123825
- **Authorized official:** BENNIE FLANAGAN (V-P)
- **Authorized official phone:** (678) 236-0400

## Contact information

- **Practice address:** 4469 LEMON ST, ACWORTH, GA 30101-5418
- **Practice address phone:** (678) 236-0400
- **Practice address fax:** (678) 236-0404
- **Mailing address:** 4469 LEMON ST, ACWORTH, GA 30101-5418
- **Mailing address phone:** (678) 236-0400
- **Mailing address fax:** (678) 236-0404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHRE008914 | GA | Yes |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 09/14/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2015785 | PK | — |
| 05 | — | 30357C | — | GA |