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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010415
GA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003199602A
—
GA
01
—
2172400
PK
—
Enumeration date
10/24/2017
Last updated
09/19/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up