Organization
LAKESIDE PHARMACY OF ALABAMA INC
Active
Other names
Lakeside Pharmacy of Alabama, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
WILL JACKS (OWNER/MANAGING PHARMACIST)
(256) 357-2315
Entity
Organization
Contact information
Practice address
17054 HIGHWAY 431, WEDOWEE, AL 36278-4572
(256) 357-2315
(256) 357-2319
Mailing address
PO BOX 10, WEDOWEE, AL 36278-0010
(256) 357-2315
(256) 357-2319
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
113866
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0137679
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/19/2012
Last updated
04/20/2012
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