Organization
LACEY DRUG CO., INC.
Active
Other names
Lacey's Marietta Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY L BRADEN RPH (OWNER)
(770) 974-5234
Entity
Organization
Contact information
Practice address
790 CHURCH ST NE STE 210, MARIETTA, GA 30060-8950
(770) 424-3131
(770) 424-2935
Mailing address
790 CHURCH ST NE, SUITE 170, MARIETTA, GA 30060-7282
(770) 424-3131
(770) 424-2935
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHRE007082
GA
333600000X
Pharmacy
PHRE007082
GA
3336C0003X
Community/Retail Pharmacy
Primary
PHRE007082
GA
3336C0004X
Compounding Pharmacy
PHRE007082
GA
3336H0001X
Home Infusion Therapy Pharmacy
PHRE0070082
GA
Other
Enumeration date
09/08/2006
Last updated
10/08/2019
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