Provider Demographics
NPI:1134467509
Name:REID, LACEY T
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:T
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MARKETPLACE CIR
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-8200
Mailing Address - Country:US
Mailing Address - Phone:205-668-3590
Mailing Address - Fax:205-668-3595
Practice Address - Street 1:90 MARKETPLACE CIR
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-8200
Practice Address - Country:US
Practice Address - Phone:205-668-3590
Practice Address - Fax:205-668-3595
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist