# PARKSIDE PHARMACY INC

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

## Provider details

- **NPI number:** 1356059224
- **Authorized official:** RANDALL LEE GERHART (OWNER)
- **Authorized official phone:** (765) 447-1000

## Contact information

- **Practice address:** 2200 FERRY ST, LAFAYETTE, IN 47904-3078
- **Practice address phone:** (765) 447-1000
- **Practice address fax:** (765) 447-4714
- **Mailing address:** 2200 FERRY ST, LAFAYETTE, IN 47904-3078
- **Mailing address phone:** (765) 447-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/09/2022
- **Last updated:** 11/09/2022

## Other identifiers

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