Canton Northside Pharmacy
LBN: Canton Northside Pharmacy Inc
Canton Northside Pharmacy is an health care organization with primary practice located at 170 Marietta Hwy , Canton GA 30114-2303. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Canton Northside Pharmacy Inc can be contacted via phone (770) 479-2171, or through Chester, Darrell via phone (770) 479-2171.
Contact Information
Primary practice address
170 Marietta Hwy
Canton GA 30114-2303
Phone: (770) 479-2171
Fax: (770) 720-6006
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 002901 | Georgia |
Profile Details
| NPI number | 1861492761 |
|---|---|
| LBN Legal business name | Canton Northside Pharmacy Inc |
| DBA Doing business as | Canton Northside Pharmacy |
| Authorized official | Chester, Darrell |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jul 21st, 2005 |
| Last updated | Jul 19th, 2018 - about 6 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861492761 | NPPES |
| Georgia | MEDICAID | 00022778A | |
| Georgia | Other | 2012090 | |
| Georgia | MEDICAID | 00022778B |
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