EXPRESS AT NORTHSIDE LLC (NPI# 1285145789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285145789 |
| Entity Type | Organization |
| Organization Name | EXPRESS AT NORTHSIDE LLC |
| Other Organization Name | EXPRESS PHARMACY |
| Practice Address |
296 Northside Dr Sw Atlanta GA 30313-1228 |
| Practice Telephone | 4045497762 |
| Practice Fax Number | 4045497625 |
| Mailing Telephone | 4045497762 |
| Mailing Fax Number | 4045497625 |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2018-07-19 |
| Authorized Official Name | KETAN TRIVEDI (MEMBER) |
| Authorized Official Telephone | 6782057038 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHRE010415 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003199602A | 05 | |
| PK | 2172400 | 01 |
| Other Name | Type Code |
|---|---|
| EXPRESS PHARMACY | Doing Business As Name - Organization |
| Street Address |
296 NORTHSIDE DR SW |
| City | ATLANTA |
| State | GA |
| Zip Code | 30313-1228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275067894 | Brittni Fleming | Counselor | 250 Park Avenue West, Atlanta, GA 30313 | 2017-04-20 |
| 1417163916 | Kelly K Hudson | Nurse Practitioner | 239 Ivan Allen Jr. Boulevard, Atlanta, GA 30313 | 2007-05-14 |
| 1134158413 | Francine Blonnetta Ricketts | Physician Assistant | 430 Centennial Olympic Park Drive, Atlanta, GA 30313 | 2006-06-30 |
| 1053348540 | Deborah Robinson Maclean | Specialist/Technologist | Healthworks/the Coca-cola Company, One Coca-cola Plaza - Hmc, Atlanta, GA 30313 | 2006-06-28 |
| 1851345904 | William C Warren Iv | Pediatrics | 239 Ivan Allen Jr Blvd, Atlanta, GA 30313 | 2006-05-22 |
| 1790222834 | Courtney Dean | Specialist/Technologist | 150 Bobby Dodd Way, Atlanta, GA 30313 | 2017-01-27 |
| 1932503711 | Emory Employer Based Health Services | Clinic/Center | 1 Coca Cola Plz Nw, Atlanta, GA 30313 | 2014-10-22 |
| 1124342019 | Professional Speech & Language Therapy, Inc | Clinic/Center | 210 Walker St Sw Unit 5, Atlanta, GA 30313-1213 | 2010-03-21 |
| 1730155144 | Javonya Donell Clemons | Speech-Language Pathologist | 210 Walker Street, Loft 5, Atlanta, GA 30313-1257 | 2006-02-24 |
| 1053506162 | Diabetic Foot Care Specialist of Georgia | Podiatrist | 238 Walker St Sw, Unit #12, Atlanta, GA 30313-1266 | 2007-09-11 |
| Find all providers in zip 30313 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043817208 | Mlk Pharmacy2.0 | Pharmacy | 2457 Mlk Jr Dr Sw Ste A, Atlanta, GA 30311-1712 | 2020-10-01 |
| 1407492119 | Capsule Atlanta LLC | Pharmacy | 867 Peachtree St Ne Ste 102, Atlanta, GA 30308-1380 | 2019-11-18 |
| 1861978793 | Uhs of Peachford Lp | Pharmacy | 2150 Peachford Rd Ste D, Atlanta, GA 30338 | 2018-07-13 |
| 1497262778 | Champions Pharmacy | Pharmacy | 3886 Princeton Lakes Way Suite 180, Atlanta, GA 30331 | 2018-01-08 |
| 1912357641 | Headland Pharmacy LLC | Pharmacy | 2973 Headland Drive, Suite B, Atlanta, GA 30331 | 2016-06-14 |
| 1285022277 | Express Food & Pharmacy Investment LLC | Pharmacy | 2111 Campbellton Rd Sw, Atlanta, GA 30311-4605 | 2014-12-30 |
| 1881024479 | Camp Creek Village Pharmacy Inc. | Pharmacy | 3220 Butner Rd Sw Suite #130, Atlanta, GA 30331 | 2013-11-18 |
| 1487093662 | Pharm Holdings | Pharmacy | 102 E Allday St, Atlanta, TX 75551-2305 | 2013-06-20 |
| 1255676326 | Eastlake Pharmacy Inc | Pharmacy | 1308 Glenwood Ave Se, Atlanta, GA 30316-2077 | 2012-11-30 |
| 1689918468 | Wal-mart Stores East Lp | Pharmacy | 835 Martin Luther King Jr Dr Nw, Atlanta, GA 30314-3644 | 2012-11-19 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.