Organization
NORTHSIDE HOSPITAL, INC.
Active
Other names
Northside Gwinnett Extended Care Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY GARDNER PHARMD, FASHP (DIRECTOR, PHARMACEUTICAL SERVICES)
(404) 851-6793
Entity
Organization
Contact information
Practice address
650 PROFESSIONAL DR, LAWRENCEVILLE, GA 30046-8707
(678) 442-3642
(770) 442-3066
Mailing address
1000 JOHNSON FERRY ROAD, ATTN: JUDY GARDNER, ATLANTA, GA 30342-1616
(404) 851-6793
(404) 851-8610
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
PHRE008388
GA
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1147215
NABP OR NCPDP
GA
05
—
866291A
—
GA
Enumeration date
12/07/2005
Last updated
11/10/2020
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