# PARKSIDE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063465904
- **Authorized official:** MR. RANDALL L GERHART BS PHARMACY (OWNER PHARMACIST)
- **Authorized official phone:** (765) 447-1000

## Contact information

- **Practice address:** 2200 FERRY ST, LAFAYETTE, IN 47904-3016
- **Practice address phone:** (765) 447-1000
- **Practice address fax:** (765) 447-4714
- **Mailing address:** 2200 FERRY ST, LAFAYETTE, IN 47904-3016
- **Mailing address phone:** (765) 447-1000
- **Mailing address fax:** (765) 447-4714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 60002772A | IN | — |
| 3336L0003X | Long Term Care Pharmacy | 60002772A | IN | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 08/15/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100301510A | — | IN |