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Organization
NORTHSIDE PHARMACY, INC.
Active
Organization
NORTHSIDE PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKI A OLIVER (OWNER)
(478) 474-6767
Entity
Organization
Contact information
Practice address
440 CHARTER BLVD, SUITE 1107, MACON, GA 31210-4857
(478) 474-6767
Mailing address
440 CHARTER BLVD, SUITE 1107, MACON, GA 31210-4857
(478) 474-6767
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
006380
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002972 39A
—
GA
Enumeration date
01/25/2007
Last updated
08/22/2020
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