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General NPI Number Information
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NPI Number | 1891673778
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Entity Type | Organization
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Legal Business Name | LAKESIDE DISCOUNT PHARMACY INC.
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 2515 ROUTE 6
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City | HAWLEY
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State | PA
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Zip | 18428-7050
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Country | US
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Telephone | 929-218-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 ROUTE 6
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City | HAWLEY
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State | PA
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Zip | 18428-7050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATAN NAGARAYEV
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Credential |
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Telephone | 929-218-3204
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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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