Organization
CANTON NORTHSIDE PHARMACY INC
Active
Other names
CANTON NORTHSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL CHESTER (PRES)
(770) 479-2171
Entity
Organization
Contact information
Practice address
170 MARIETTA HWY, CANTON, GA 30114-2303
(770) 479-2171
(770) 720-6006
Mailing address
PO BOX 4460, CANTON, GA 30114-0200
(770) 479-2171
(770) 720-6006
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
002901
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00022778A
—
GA
05
—
00022778B
—
GA
01
—
2012090
PK
—
Enumeration date
07/21/2005
Last updated
09/19/2025
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