| NPI | 1306622964 |
|---|---|
| Doing Business As | LAKESIDE PHARMACY LTC |
| Entity Type | Organization |
| Authorized Contact | PATRICK WILLIAM FREY President 715-623-2631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-11-14 |