Provider Demographics
NPI:1871233908
Name:LANCE, LACEY BREANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:BREANNE
Last Name:LANCE
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 1:274 SUTTON RD SE
Mailing Address - Street 2:
Mailing Address - City:BIG COVE
Mailing Address - State:AL
Mailing Address - Zip Code:35763-8753
Mailing Address - Country:US
Mailing Address - Phone:256-533-8982
Mailing Address - Fax:
Practice Address - Street 1:274 SUTTON RD SE
Practice Address - Street 2:
Practice Address - City:BIG COVE
Practice Address - State:AL
Practice Address - Zip Code:35763-8753
Practice Address - Country:US
Practice Address - Phone:256-533-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist