# LACEY DRUG CO., INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lacey's Marietta Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477657898
- **Authorized official:** MR. LARRY L BRADEN RPH (OWNER)
- **Authorized official phone:** (770) 974-5234

## Contact information

- **Practice address:** 790 CHURCH ST NE STE 210, MARIETTA, GA 30060-8950
- **Practice address phone:** (770) 424-3131
- **Practice address fax:** (770) 424-2935
- **Mailing address:** 790 CHURCH ST NE, SUITE 170, MARIETTA, GA 30060-7282
- **Mailing address phone:** (770) 424-3131
- **Mailing address fax:** (770) 424-2935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | PHRE007082 | GA | — |
| 333600000X | Pharmacy | PHRE007082 | GA | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE007082 | GA | Yes |
| 3336C0004X | Compounding Pharmacy | PHRE007082 | GA | — |
| 3336H0001X | Home Infusion Therapy Pharmacy | PHRE0070082 | GA | — |

## Other

- **Enumeration date:** 09/08/2006
- **Last updated:** 10/08/2019