| NPI | 1275860785 |
|---|---|
| Doing Business As | LAKESIDE MARKET |
| Entity Type | Organization |
| Authorized Contact | JOHN O DAHLSTROM President 715-468-2319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2009-11-05 |