# LAKESIDE PHARMACY OF ALABAMA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside Pharmacy of Alabama, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518232941
- **Authorized official:** WILL JACKS (OWNER/MANAGING PHARMACIST)
- **Authorized official phone:** (256) 357-2315

## Contact information

- **Practice address:** 17054 HIGHWAY 431, WEDOWEE, AL 36278-4572
- **Practice address phone:** (256) 357-2315
- **Practice address fax:** (256) 357-2319
- **Mailing address:** PO BOX 10, WEDOWEE, AL 36278-0010
- **Mailing address phone:** (256) 357-2315
- **Mailing address fax:** (256) 357-2319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 113866 | AL | Yes |

## Other

- **Enumeration date:** 03/19/2012
- **Last updated:** 04/20/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0137679 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |