Individual
LACEY BOUTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(706) 272-6450
Mailing address
814 BRYNEWOOD PARK LN, CHATTANOOGA, TN 37415-2305
(770) 856-4360
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH031896
GA
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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