| NPI | 1043321896 |
|---|---|
| Doing Business As | LAKESIDE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KYLE MAXWELL President/Tres. 802-862-1491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-03-07 |