Organization
LACEY DRUG COMPANY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL JERAULD (DME MANAGER)
(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
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030357B
—
GA
Enumeration date
10/25/2006
Last updated
11/07/2008
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