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Organization
CANTON NORTHSIDE PHARMACY INC
Active
Organization
CANTON NORTHSIDE PHARMACY INC
Active
Other names
NORTHSIDE PHARMACY WALESKA
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL CHESTER RPH (PRESIDENT)
(770) 479-2171
Entity
Organization
Contact information
Practice address
6824 REINHARDT COLLEGE PKWY, WALESKA, GA 30183-3266
(770) 479-2172
(770) 479-2249
Mailing address
PO BOX 1029, WALESKA, GA 30183-1029
(770) 479-2172
(770) 720-6006
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009402
GA
Other
Enumeration date
10/18/2007
Last updated
04/12/2017
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