| NPI | 1346517356 |
|---|---|
| Former Name | LACEY M BLACKBURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IL 051.290110) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2003018316) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2015-11-24 |