Basic Information
| Provider Information | |||||||||
| NPI: | 1730616301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | LACY | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2731 SW GAINSBORO RD | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666144346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857830209 | ||||||||
| FaxNumber: | 7852351979 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 SW OAKLEY AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857830209 | ||||||||
| FaxNumber: | 7852351979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2017 | ||||||||
| LastUpdateDate: | 05/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1-16432 | KS | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.