Provider Demographics
NPI:1093866212
Name:NORTH SIDE PHARMACY, INC.
Entity Type:Organization
Organization Name:NORTH SIDE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANNGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PETKOVSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-542-4481
Mailing Address - Street 1:1601 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3445
Mailing Address - Country:US
Mailing Address - Phone:972-542-4481
Mailing Address - Fax:972-542-3709
Practice Address - Street 1:1601 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3445
Practice Address - Country:US
Practice Address - Phone:972-542-4481
Practice Address - Fax:972-542-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX01911333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4511829OtherPHARMACY NABP
TX4511829OtherPHARMACY NABP