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Individual

MRS. LACEY DEYANNE BUCKHANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1509 S NEIL ST, CHAMPAIGN, IL 61820-6580
(217) 351-1516
Mailing address
480 MACON ST, MAHOMET, IL 61853-9421
(217) 721-8731

Taxonomy

Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
049137234
IL

Other

Enumeration date
02/09/2023
Last updated
02/09/2023
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