OrganizationActive
Lakeside Pharmacy LLC
NPI 1013239417 · Community/Retail Pharmacy · Montgomery, TX
Provider details
- NPI number
- 1013239417
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Kim Prezioso, President/Pharm-In-Charge(936) 827-3766
Specialties & taxonomies
Suppliers
- Compounding Pharmacy3336C0004X
Suppliers
Suppliers
- Pharmacy333600000X
Suppliers
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
16955 Walden Rd Ste 100
Montgomery, TX 77356-3227
Phone: (936) 448-6337
Fax: (936) 448-6338
Street-level locationGet directions
Mailing address
16955 Walden Rd
Montgomery, TX 77356-3220
Other names (DBA / former)
- Doing business as
- Lakeside Pharmacy
Registry dates
- Enumerated
- 2010-02-26
- Last updated
- 2010-04-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.