| NPI | 1417514860 |
|---|---|
| Former Name | LACY REBECCA BASSHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 19416) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AR PD11635) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2019-05-21 |