| NPI | 1740507334 |
|---|---|
| Doing Business As | LAKESIDE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | DARREN TIDWELL Owner 918-689-9940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: OK 48-5526) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OK 48-5526) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2010-04-23 |