Provider Demographics
NPI:1043652191
Name:GALLAGHER, LACY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LACY
Middle Name:ANN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 RIVER HAVEN CIR APT P
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4125
Mailing Address - Country:US
Mailing Address - Phone:843-368-1427
Mailing Address - Fax:
Practice Address - Street 1:1810 N HIGHWAY 17
Practice Address - Street 2:WALGREEN'S #7156
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3309
Practice Address - Country:US
Practice Address - Phone:843-388-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist