# LAKESIDE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside Pharmacy LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780468884
- **Authorized official:** KIM HARRIGAN PREZIOSO BSN, PHARMD (OWNER/PIC)
- **Authorized official phone:** (936) 448-6337

## Contact information

- **Practice address:** 16955 WALDEN RD STE 100, MONTGOMERY, TX 77356-3227
- **Practice address phone:** (936) 448-6337
- **Practice address fax:** (936) 448-6338
- **Mailing address:** 16955 WALDEN RD STE 100, MONTGOMERY, TX 77356-3227
- **Mailing address phone:** (936) 448-6337
- **Mailing address fax:** (936) 448-6338

## Taxonomy

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

## Other

- **Enumeration date:** 08/21/2023
- **Last updated:** 08/21/2023