Provider Demographics
NPI:1912487133
Name:HUDANICH, LACEY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:ANN
Last Name:HUDANICH
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 1:15 S HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3702
Mailing Address - Country:US
Mailing Address - Phone:412-398-6056
Mailing Address - Fax:
Practice Address - Street 1:15 S HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3702
Practice Address - Country:US
Practice Address - Phone:412-398-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443521183500000X
AZS016272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist