Provider Demographics
NPI:1487937876
Name:WALDEN, LACEY (PHARMD)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:WALDEN
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 1:4333 BELL RD
Mailing Address - Street 2:UNIT 516
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8177
Mailing Address - Country:US
Mailing Address - Phone:502-415-4709
Mailing Address - Fax:
Practice Address - Street 1:1601 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4347
Practice Address - Country:US
Practice Address - Phone:812-477-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024328A183500000X
KY015642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist