Provider Demographics
NPI:1073273322
Name:ROBISON, LACY ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:ELIZABETH
Last Name:ROBISON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 PERSIMMON PL
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-9342
Mailing Address - Country:US
Mailing Address - Phone:573-380-4423
Mailing Address - Fax:
Practice Address - Street 1:2220 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1329
Practice Address - Country:US
Practice Address - Phone:573-264-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist