# MAXWELLS PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MAXWELLS PHARMACY INC
- **Other names:** Lakeside Pharmacy LTC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558039644
- **Legal business name:** MAXWELLS PHARMACY INC
- **Authorized official:** KYLE MAXWELL (PRESIDENT/ TREAS.)
- **Authorized official phone:** (802) 862-1562

## Contact information

- **Practice address:** 242 PEARL ST, BURLINGTON, VT 05401-8532
- **Practice address phone:** (802) 862-1491
- **Practice address fax:** (802) 865-2208
- **Mailing address:** 242 PEARL ST, BURLINGTON, VT 05401-8532
- **Mailing address phone:** (802) 862-1491
- **Mailing address fax:** (802) 865-2208

## Taxonomy

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

## Other

- **Enumeration date:** 09/02/2021
- **Last updated:** 09/02/2021