# CANTON NORTHSIDE PHARMACY INC

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

## Provider details

- **NPI number:** 1861492761
- **Authorized official:** DARRELL CHESTER (PRES)
- **Authorized official phone:** (770) 479-2171

## Contact information

- **Practice address:** 170 MARIETTA HWY, CANTON, GA 30114-2303
- **Practice address phone:** (770) 479-2171
- **Practice address fax:** (770) 720-6006
- **Mailing address:** PO BOX 4460, CANTON, GA 30114-0200
- **Mailing address phone:** (770) 479-2171
- **Mailing address fax:** (770) 720-6006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 002901 | GA | Yes |

## Other

- **Enumeration date:** 07/21/2005
- **Last updated:** 09/19/2025