Individual
LACEY JAY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
4302 W BUCKEYE RD STE 109, PHOENIX, AZ 85043-4904
(800) 379-0092
Mailing address
4302 W BUCKEYE RD STE 109, PHOENIX, AZ 85043-4904
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
21887
IA
183500000X
Pharmacist
Primary
S019202
AZ
Other
Enumeration date
07/15/2012
Last updated
06/14/2022
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