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NPI Code Detail

MEDICARE: LAKESIDE MEMORIAL HOSPITAL INC

MEDICARE: LAKESIDE MEMORIAL HOSPITAL INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy
23336L0003XLong Term Care Pharmacy
33336I0012XInstitutional Pharmacy012799NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23349037OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1225071566
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESIDE MEMORIAL HOSPITAL INC
Provider Business Mailing Address
First Line : 156 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1229
Country : US
Telephone Number : 585-395-6043
Fax Number : 585-395-6022
Provider Business Practice Location Address
First Line : 156 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1229
Country : US
Telephone Number : 585-395-6043
Fax Number : 585-395-6022
Authorized Official
Title or Position : DIRECTOR FO PHARMACY
Name : CHRISTOPHER DAILEY
Credential :
Telephone Number : 585-395-6043
Provider Enumeration Date : 06/14/2006
Last Update Date : 01/07/2013

Similar Medicare Providers

1942271218 — DR. DIDEM MIRALOGLU M.D., M.S.
Practice Location Address:
156 WEST AVE , SUITE 106
BROCKPORT, NY
14420-1229
Practice Phone: 585-637-7558
Practice Fax: 585-637-7566
1477514693 — STEPHEN F WIECZOREK DPM
Practice Location Address:
156 WEST AVE , SUITE 106
BROCKPORT, NY
14420-1229
Practice Phone: 585-637-2113
Practice Fax:
1700849957 — HARRY M SHIFTON PHARMACIST
Practice Location Address:
156 WEST AVE
BROCKPORT, NY
14420-1229
Practice Phone: 585-395-6043
Practice Fax:
1639136153 — LAKESIDE MEMORIAL HOSPITAL INC.
Practice Location Address:
156 WEST AVE
BROCKPORT, NY
14420-1229
Practice Phone: 585-395-6095
Practice Fax: 585-395-6036
1336180744 — JASON MCCLUNG MD
Practice Location Address:
156 WEST AVE , EMERGENCY DEPARTMENT
BROCKPORT, NY
14420-1229
Practice Phone: 585-395-6095
Practice Fax: 585-395-6017
1033146410 — ERIK PETERSON D.O.
Practice Location Address:
156 WEST AVE , EMERGENCY DEPARTMENT
BROCKPORT, NY
14420-1229
Practice Phone: 585-395-6095
Practice Fax: 585-395-6017

Directions to “LAKESIDE MEMORIAL HOSPITAL INC ” Practice Location

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