Provider Demographics
NPI:1083089759
Name:MADISON, LACEY CALDWELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:CALDWELL
Last Name:MADISON
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 1:1980 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-2110
Mailing Address - Country:US
Mailing Address - Phone:828-698-1116
Mailing Address - Fax:828-698-9579
Practice Address - Street 1:1980 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2110
Practice Address - Country:US
Practice Address - Phone:828-698-1116
Practice Address - Fax:828-698-9579
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist