Provider Demographics
NPI:1760644314
Name:BLANKENSHIP, LACEY KAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:KAY
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31870 E HWY 51
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-0000
Mailing Address - Country:US
Mailing Address - Phone:918-279-3407
Mailing Address - Fax:918-279-1094
Practice Address - Street 1:31870 E HWY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429
Practice Address - Country:US
Practice Address - Phone:918-279-3407
Practice Address - Fax:918-279-1094
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist