Provider Demographics
NPI:1699060988
Name:LACIAK, MARJORIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:LACIAK
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 1:1001 STURDY RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4126
Mailing Address - Country:US
Mailing Address - Phone:219-465-9505
Mailing Address - Fax:219-465-9519
Practice Address - Street 1:1001 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4126
Practice Address - Country:US
Practice Address - Phone:219-465-9505
Practice Address - Fax:219-465-9519
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020771A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist