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Organization
LAKE SIDE PHARMACY
Active
Organization
LAKE SIDE PHARMACY
Active
Other names
Total Life Care Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN WILSON PHARM.D. (PHARMACIST IN CHARGE)
(844) 236-5360
Entity
Organization
Contact information
Practice address
10005 AL HIGHWAY 9 N, CEDAR BLUFF, AL 35959-2231
(844) 236-5360
(866) 609-4582
Mailing address
10005 AL HIGHWAY 9 N, CEDAR BLUFF, AL 35959-2231
(844) 236-5360
(866) 609-4582
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
113926
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113926
ALABAMA PHARMACY LICENSE NUMBER
AL
Enumeration date
06/19/2012
Last updated
01/03/2017
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