Provider Demographics
NPI:1487367546
Name:FERGUSON, LACEY MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:MARIE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 430TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:50585-2041
Mailing Address - Country:US
Mailing Address - Phone:712-260-8982
Mailing Address - Fax:
Practice Address - Street 1:1200 1ST AVE E STE 1
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4330
Practice Address - Country:US
Practice Address - Phone:712-264-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist