Provider Demographics
NPI:1356333868
Name:NORTHSIDE HOSPITAL
Entity Type:Organization
Organization Name:NORTHSIDE HOSPITAL
Other - Org Name:NORTHSIDE HOSPITAL FORSYTH PHARMACY DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-844-3291
Mailing Address - Street 1:1200 NORTHSIDE FORSYTH DR
Mailing Address - Street 2:NORTHSIDE HOSPITAL FORSYTH PHARMACY
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7659
Mailing Address - Country:US
Mailing Address - Phone:770-844-3290
Mailing Address - Fax:770-844-3424
Practice Address - Street 1:1200 NORTHSIDE FORSYTH DR
Practice Address - Street 2:NORTHSIDE HOSPITAL FORSYTH PHARMACY
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7659
Practice Address - Country:US
Practice Address - Phone:770-844-3291
Practice Address - Fax:770-844-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHH007473333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy