Organization
LACEY DRUG COMPANY INC
Active
Other names
LACEY DRUG COMPANY
Organization subpart
No
Provider details
NPI number
Authorized official
BEN FLANAGAN (VP)
(770) 974-3131
Entity
Organization
Contact information
Practice address
4797 S MAIN ST, ACWORTH, GA 30101-5339
(770) 974-3131
(770) 975-9735
Mailing address
4797 S MAIN ST, ACWORTH, GA 30101-5339
(770) 974-3131
(770) 975-9735
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE002433
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030357
—
GA
01
—
2016366
PK
—
05
—
30019170A
—
GA
Enumeration date
09/12/2006
Last updated
03/02/2016
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