Organization
HYPERION LLC
Active
Other names
Lakeside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN TIDWELL (OWNER)
(918) 689-9940
Entity
Organization
Contact information
Practice address
605 N MAIN ST, EUFAULA, OK 74432-1634
(918) 689-9940
(918) 689-7557
Mailing address
605 N MAIN ST, EUFAULA, OK 74432-1634
(918) 689-9940
(918) 689-7557
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
48-5526
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287060A
—
OK
01
—
2125414
PK
—
Enumeration date
03/12/2007
Last updated
05/27/2015
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