Provider Demographics
NPI:1447532593
Name:DONNELL, LACEY MICHELE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:MICHELE
Last Name:DONNELL
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 1:210 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3701
Mailing Address - Country:US
Mailing Address - Phone:918-298-2691
Mailing Address - Fax:918-298-2592
Practice Address - Street 1:210 S ELM ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3701
Practice Address - Country:US
Practice Address - Phone:918-298-2691
Practice Address - Fax:918-298-2592
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist