Provider Demographics
NPI:1003427659
Name:GARNER, LACEY ALTON JR (RPH)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ALTON
Last Name:GARNER
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-7387
Mailing Address - Country:US
Mailing Address - Phone:910-947-2690
Mailing Address - Fax:910-947-3878
Practice Address - Street 1:1006 MONROE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-7387
Practice Address - Country:US
Practice Address - Phone:910-947-2690
Practice Address - Fax:910-947-3878
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist