Organization
LAKESIDE FAMILY PHARMACY LLC
Active
Other names
Lakeside Family Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
APOLLON CONSTANTINIDES RPH (OWNER)
(770) 781-1450
Entity
Organization
Contact information
Practice address
1505 NORTHSIDE BLVD, STE 1600, CUMMING, GA 30041-7623
(770) 781-1450
(770) 781-1455
Mailing address
1505 NORTHSIDE BLVD, STE 1600, CUMMING, GA 30041-7623
(770) 781-1450
(770) 781-1455
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009517
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1157862
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/21/2008
Last updated
03/15/2011
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