Organization
PARKSIDE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL LEE GERHART (OWNER)
(765) 447-1000
Entity
Organization
Contact information
Practice address
2200 FERRY ST, LAFAYETTE, IN 47904-3078
(765) 447-1000
(765) 447-4714
Mailing address
2200 FERRY ST, LAFAYETTE, IN 47904-3078
(765) 447-1000
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100301510A
—
IN
Enumeration date
11/09/2022
Last updated
11/09/2022
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