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General NPI Number Information
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NPI Number | 1225071566
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Entity Type | Organization
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Legal Business Name | LAKESIDE MEMORIAL HOSPITAL INC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 156 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1229
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Country | US
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Telephone | 585-395-6043
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Fax | 585-395-6022
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Provider Business Mailing Address
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Address Line | 156 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1229
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Country | US
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Telephone | 585-395-6043
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Fax | 585-395-6022
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Authorized Official
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Title or Position | DIRECTOR FO PHARMACY
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Name | CHRISTOPHER DAILEY
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Credential |
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Telephone | 585-395-6043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 012799
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License Number State | NY
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