Organization
HYPERION, LLC
Active
Other names
Lakeside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN TIDWELL DPH (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
332B00000X
Durable Medical Equipment & Medical Supplies
48-5526
OK
3336C0003X
Community/Retail Pharmacy
Primary
48-5526
OK
Other
Enumeration date
04/23/2010
Last updated
04/23/2010
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