Provider Demographics
NPI:1003419201
Name:LACY, BRETT WILLIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:WILLIAM
Last Name:LACY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-4346
Mailing Address - Country:US
Mailing Address - Phone:184-752-9476
Mailing Address - Fax:
Practice Address - Street 1:2920 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1903
Practice Address - Country:US
Practice Address - Phone:210-532-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist