Lacey Drug Company, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LACEY DRUG COMPANY, INC

Practice address

4797 S Main St
Acworth, GA 30101-5339

Phone

(770) 974-3131

Fax

(770) 975-9735

NPI assigned

Oct 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carol Jerauld

Title

DME Manager

Phone

(770) 974-3131

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Lacey Drug Company Inc

  dba Lacey Drug Company

  • Community/Retail Pharmacy
  • Acworth, GA
  • NPI 1548364292

  9133118508

  Same PAC ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226016000000",
    "number": "1831273747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4797 S MAIN ST",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015339",
            "telephone_number": "770-974-3131",
            "fax_number": "770-975-9735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4797 S MAIN ST",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015339",
            "telephone_number": "770-974-3131",
            "fax_number": "770-975-9735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACEY DRUG COMPANY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-11-07",
        "status": "A",
        "authorized_official_last_name": "JERAULD",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "DME MANAGER",
        "authorized_official_telephone_number": "770-974-3131",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00030357B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Ann Krol, M.S., CCC-SLP
• Caleb Thomas Kutsche, PT, DPT, CSCS
• Emily Labutta
• Lacey Drug Company Inc (Laceys LTC Pharmacy)
• Lacey Drug Company Inc (Lacey Drug Company)
• Julia Ladd
• Michelle Laden
• Lake Acworth Family Practice
• Lake City Chiropractic Center
• Lake Pointe Chiropractic LLC

• Durable Medical Equipment & Medical Supplies in Acworth, GA
• Providers in Acworth, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.