Provider Demographics
NPI:1629313069
Name:GARRETT, LACI LOVE (RPH,PHARMD)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:LOVE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12591 YARDARM PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2122
Mailing Address - Country:US
Mailing Address - Phone:703-494-0113
Mailing Address - Fax:
Practice Address - Street 1:12591 YARDARM PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2122
Practice Address - Country:US
Practice Address - Phone:703-494-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist