# LAKE SIDE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Total Life Care Compounding
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093078768
- **Authorized official:** DR. STEPHEN WILSON PHARM.D. (PHARMACIST IN CHARGE)
- **Authorized official phone:** (844) 236-5360

## Contact information

- **Practice address:** 10005 AL HIGHWAY 9 N, CEDAR BLUFF, AL 35959-2231
- **Practice address phone:** (844) 236-5360
- **Practice address fax:** (866) 609-4582
- **Mailing address:** 10005 AL HIGHWAY 9 N, CEDAR BLUFF, AL 35959-2231
- **Mailing address phone:** (844) 236-5360
- **Mailing address fax:** (866) 609-4582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 113926 | AL | Yes |

## Other

- **Enumeration date:** 06/19/2012
- **Last updated:** 01/03/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 113926 | ALABAMA PHARMACY LICENSE NUMBER | AL |