Individual
MS. LACEY JO HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM. D.
Contact information
Practice address
4325 SE 82ND AVE, PORTLAND, OR 97266-2919
(503) 775-9603
Mailing address
4325 SE 82ND, PORTLAND, OR 97266
(503) 775-9603
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0011065
OR
Other
Enumeration date
09/17/2009
Last updated
09/17/2009
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