| NPI | 1558039644 |
|---|---|
| Other Name | LAKESIDE PHARMACY LTC |
| Entity Type | Organization |
| Authorized Contact | KYLE MAXWELL President/ Treas. 802-862-1562 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2021-09-02 |