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Organization
EXPRESS AT NORTHSIDE LLC
Active
Organization
EXPRESS AT NORTHSIDE LLC
Active
Other names
EXPRESS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN TRIVEDI (MEMBER)
(678) 205-7038
Entity
Organization
Contact information
Practice address
296 NORTHSIDE DR SW, ATLANTA, GA 30313-1228
(404) 549-7762
(404) 549-7625
Mailing address
296 NORTHSIDE DR SW, ATLANTA, GA 30313-1228
(404) 549-7762
(404) 549-7625
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010415
GA
3336C0004X
Compounding Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Enumeration date
10/24/2017
Last updated
09/19/2025
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