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General NPI Number Information
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NPI Number | 1245723725
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Entity Type | Organization
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Legal Business Name | LAKESIDE PHARMACY LLC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 9615 SHERRILL ESTATES RD STE B
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6552
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Country | US
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Telephone | 980-441-8600
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Fax | 980-444-8625
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Provider Business Mailing Address
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Address Line | 9615 SHERRILL ESTATES RD SUITE B
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6552
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Country | US
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Telephone | 980-441-8600
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Fax | 980-444-8625
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Authorized Official
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Title or Position | MANAGER
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Name | THANVEER REDDY GADWAL
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Credential | PHARMD
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Telephone | 980-441-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 13756
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License Number State | NC
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