Provider Demographics
NPI:1598867756
Name:LACY, CARLOS N (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:N
Last Name:LACY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S JOE WILSON RD APT 1016
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2940
Mailing Address - Country:US
Mailing Address - Phone:214-857-0561
Mailing Address - Fax:214-857-0585
Practice Address - Street 1:V A NORTH TEXAS HEALTH CARE SYSTEM (119)
Practice Address - Street 2:4500 SOUTH LANCASTER ROAD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7191
Practice Address - Country:US
Practice Address - Phone:214-857-0561
Practice Address - Fax:214-857-0585
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist