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General NPI Number Information
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NPI Number | 1750425211
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Entity Type | Organization
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Legal Business Name | LAKESHORE PHARMACY, INC.
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 W LAKESHORE DR SUITE 102
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City | BIRMINGHAM
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State | AL
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Zip | 35209-0500
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Country | US
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Telephone | 205-945-8081
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Fax | 205-945-8508
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Provider Business Mailing Address
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Address Line | 1 W LAKESHORE DR SUITE 102
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City | BIRMINGHAM
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State | AL
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Zip | 35209-0500
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Country | US
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Telephone | 205-945-8081
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Fax | 205-945-8508
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT ERNEST BRYANT III
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Credential |
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Telephone | 205-945-8081
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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 | 112213
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License Number State | AL
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