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General NPI Number Information
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NPI Number | 1801185574
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Entity Type | Organization
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Legal Business Name | LAKESIDE PHARMACY INC.
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 998 SHADY GROVE RD UNIT 1-H
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8094
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Country | US
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Telephone | 501-262-5400
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Fax | 501-262-5404
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Provider Business Mailing Address
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Address Line | 998 SHADY GROVE RD STE 1H
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8094
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Country | US
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Telephone | 501-262-5400
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Fax | 501-262-5404
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID E LECHAK
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Credential | PD
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Telephone | 501-262-5400
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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 | AR20646
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License Number State | AR
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