Organization
LAKESIDE PHARMACY, LLC
Active
Other names
Lakeside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. APOLLON ANTHONY CONSTANTINIDES JR. PHARM D (PRESIDENT)
(770) 205-0290
Entity
Organization
Contact information
Practice address
1505 NORTHSIDE BLVD STE 1600, CUMMING, GA 30041-7660
(770) 205-0290
(770) 205-7386
Mailing address
1505 NORTHSIDE BLVD STE 1600, CUMMING, GA 30041-7660
(770) 205-0290
(770) 205-7386
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
008517
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00913811A
—
GA
Enumeration date
03/12/2007
Last updated
05/07/2025
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