Organization
LAKESIDE PHARMACY LLC
Active
Other names
Lakeside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
THANVEER REDDY GADWAL PHARMD (MANAGER)
(980) 441-8600
Entity
Organization
Contact information
Practice address
9615 SHERRILL ESTATES RD STE B, HUNTERSVILLE, NC 28078-6552
(980) 441-8600
(980) 444-8625
Mailing address
9615 SHERRILL ESTATES RD, SUITE B, HUNTERSVILLE, NC 28078-6552
(980) 441-8600
(980) 444-8625
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13756
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245723725
—
NC
01
—
2177949
PK
—
05
—
7Z1352
—
SC
Enumeration date
06/11/2018
Last updated
10/31/2025
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