Organization
LAKESIDE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON HUTTON (OWNER)
(951) 245-7699
Entity
Organization
Contact information
Practice address
31681 RIVERSIDE DR, STE D, LAKE ELSINORE, CA 92530-7815
(951) 245-7699
(951) 245-7721
Mailing address
31681 RIVERSIDE DR, STE D, LAKE ELSINORE, CA 92530-7815
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY47386
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5623283
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
07/08/2008
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