| NPI | 1013239417 |
|---|---|
| Doing Business As | LAKESIDE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KIM PREZIOSO President/Pharm In Charge 936-827-3766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 26843) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2010-04-07 |