| NPI | 1477657898 |
|---|---|
| Doing Business As | LACEY'S MARIETTA PHARMACY |
| Entity Type | Organization |
| Authorized Contact | LARRY L BRADEN Owner 770-974-5234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA PHRE007082) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA PHRE007082) |
| 333600000X Pharmacy (Licence: GA PHRE007082) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: GA PHRE007082) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: GA PHRE0070082) | |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2019-10-08 |