Provider Demographics
NPI:1447240221
Name:LACEY, AUDREY LOUISE (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:LOUISE
Last Name:LACEY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 PIONEER WAY E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3684
Mailing Address - Country:US
Mailing Address - Phone:253-845-7259
Mailing Address - Fax:
Practice Address - Street 1:14701 PIONEER WAY E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3684
Practice Address - Country:US
Practice Address - Phone:253-845-7259
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist