Organization
PARKSIDE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL L GERHART BS PHARMACY (OWNER PHARMACIST)
(765) 447-1000
Entity
Organization
Contact information
Practice address
2200 FERRY ST, LAFAYETTE, IN 47904-3016
(765) 447-1000
(765) 447-4714
Mailing address
2200 FERRY ST, LAFAYETTE, IN 47904-3016
(765) 447-1000
(765) 447-4714
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
60002772A
IN
3336L0003X
Long Term Care Pharmacy
Primary
60002772A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100301510A
—
IN
Enumeration date
05/19/2006
Last updated
08/15/2016
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