Provider Demographics
NPI:1194331330
Name:LAIL, MACIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MACIE
Middle Name:
Last Name:LAIL
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 1:2544 WEDDINGTON AVE APT 2408
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-1010
Mailing Address - Country:US
Mailing Address - Phone:828-381-2079
Mailing Address - Fax:
Practice Address - Street 1:900 METROPOLITAN AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3262
Practice Address - Country:US
Practice Address - Phone:704-973-3122
Practice Address - Fax:704-973-3132
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist