Lake Side Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

113926 Issued in AL

Legal business name

LAKE SIDE PHARMACY

Practice address

10005 Al Highway 9 N
Cedar Bluff, AL 35959-2231

Phone

(844) 236-5360

Fax

(866) 609-4582

NPI assigned

Jun 19, 2012

Last updated

Jan 3, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Wilson, PHARM.D.NPI 1750736963

Title

Pharmacist in Charge

Phone

(844) 236-5360

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Total Life Care Compounding Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen Wilson, PHARM.D.

  • Pharmacist
  • Cedar Bluff, AL
  • NPI 1750736963
  NPD (past) Authorized official

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483401600000",
    "number": "1093078768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10005 AL HIGHWAY 9 N",
            "city": "CEDAR BLUFF",
            "state": "AL",
            "postal_code": "359592231",
            "telephone_number": "844-236-5360",
            "fax_number": "866-609-4582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10005 AL HIGHWAY 9 N",
            "city": "CEDAR BLUFF",
            "state": "AL",
            "postal_code": "359592231",
            "telephone_number": "844-236-5360",
            "fax_number": "866-609-4582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SIDE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-19",
        "last_updated": "2017-01-03",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "844-236-5360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "113926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA PHARMACY LICENSE NUMBER",
            "identifier": "113926",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Total Life Care Compounding",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Beverly Maria Cranford, CPM, MSM, LM
• Kristi Lynn Hardin, NP
• Romaine H Heard, CRNP
• Homecare Heros LLC (Dawn M Little)
• Johnson RX Properties, LLC (Johnson RX Pharmacy)
• Dawn M Little, CNA
• Mountain Home Birth & Midwifery LLC
• Quality of Life Health Services, Inc (Cherokee Quality Health Care)
• Melba Joy Rogers, R
• Larry Keith Scarborough, M. D.

• Community/Retail Pharmacy in Cedar Bluff, AL
• Providers in Cedar Bluff, AL by specialty
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; 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.