# EASTSIDE CLINIC PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eastside Pharmacy LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427841360
- **Authorized official:** JESSE WILSON PHARMD (PIC/OWNER)
- **Authorized official phone:** (580) 355-6400

## Contact information

- **Practice address:** 3612 SE LEE BLVD, LAWTON, OK 73501-8451
- **Practice address phone:** (580) 355-6400
- **Practice address fax:** (580) 355-0451
- **Mailing address:** 3612 SE LEE BLVD, LAWTON, OK 73501-8451
- **Mailing address phone:** (580) 355-6400

## Taxonomy

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

## Other

- **Enumeration date:** 05/23/2025
- **Last updated:** 05/23/2025