Provider Demographics
NPI:1700901634
Name:LACEY, CASSIE COLLEEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:COLLEEN
Last Name:LACEY
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 1:1218 CRANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9671
Mailing Address - Country:US
Mailing Address - Phone:828-808-2421
Mailing Address - Fax:
Practice Address - Street 1:123 PARK ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-4319
Practice Address - Country:US
Practice Address - Phone:828-235-8414
Practice Address - Fax:828-235-9196
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist