Lakeside Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

26843 Issued in TX

Legal business name

LAKESIDE PHARMACY LLC

Practice address

16955 Walden Rd Ste 100
Montgomery, TX 77356-3227

Phone

(936) 448-6337

Fax

(936) 448-6338

NPI assigned

Feb 26, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kim Prezioso

Title

President/Pharm-in-Charge

Phone

(936) 827-3766

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Lakeside Pharmacy Doing business as

Tax ID family

Lakeside Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lakeside Pharmacy LLC

  • Long Term Care Pharmacy
  • Montgomery, TX
  • NPI 1780468884
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785715200000",
    "number": "1013239417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16955 WALDEN RD",
            "address_2": "SUITE 100",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773563220",
            "telephone_number": "936-448-6337",
            "fax_number": "936-448-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16955 WALDEN RD STE 100",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773563227",
            "telephone_number": "936-448-6337",
            "fax_number": "936-448-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-26",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A",
        "authorized_official_last_name": "PREZIOSO",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PRESIDENT/PHARM-IN-CHARGE",
        "authorized_official_telephone_number": "936-827-3766"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "26843",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4555186",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wendy Kuo, OD
• Lake Area Emergency Center LLC
• Lake Area Pediatrics
• Lake Conroe Counseling Center, PLLC
• Lake Conroe Physical Therapy and Rehabilitation Services, Inc.
• Lakeside Pharmacy LLC
• Lakeside Sleep Center LLC
• Wilmot Lambert, RN
• Lcpdsmiles PLLC
• Tien Le, PHARMD

• Community/Retail Pharmacy in Montgomery, TX
• Providers in Montgomery, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.