# EXPRESS AT NORTHSIDE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EXPRESS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285145789
- **Authorized official:** KETAN TRIVEDI (MEMBER)
- **Authorized official phone:** (678) 205-7038

## Contact information

- **Practice address:** 296 NORTHSIDE DR SW, ATLANTA, GA 30313-1228
- **Practice address phone:** (404) 549-7762
- **Practice address fax:** (404) 549-7625
- **Mailing address:** 296 NORTHSIDE DR SW, ATLANTA, GA 30313-1228
- **Mailing address phone:** (404) 549-7762
- **Mailing address fax:** (404) 549-7625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE010415 | GA | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/24/2017
- **Last updated:** 09/19/2025