Organization
LAKE SIDE PHARMACY
Active
Other names
Total Life Care Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN WILSON PHARM.D. (PHARMACIST IN CHARGE)
(844) 236-5360
Entity
Organization
Contact information
Practice address
10005 AL HIGHWAY 9 N, CEDAR BLUFF, AL 35959-2231
(844) 236-5360
(866) 609-4582
Mailing address
10005 AL HIGHWAY 9 N, CEDAR BLUFF, AL 35959-2231
(844) 236-5360
(866) 609-4582
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
113926
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113926
ALABAMA PHARMACY LICENSE NUMBER
AL
Enumeration date
06/19/2012
Last updated
01/03/2017
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