Provider Demographics
NPI:1710621677
Name:KLUCK, LACEY KAREN
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:KAREN
Last Name:KLUCK
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 1:302 E HOWARD ST STE 230
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-4203
Mailing Address - Country:US
Mailing Address - Phone:218-421-6350
Mailing Address - Fax:
Practice Address - Street 1:302 E HOWARD ST STE 230
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-4203
Practice Address - Country:US
Practice Address - Phone:218-421-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician