MEDICARE: NORTHSIDE HOSPITAL HOMECARE PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	006234	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639178213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSIDE HOSPITAL HOMECARE PHARMACY

Provider Business Mailing Address
First Line	:	1000 JOHNSON FERRY RD NE
Second Line	:	HOMECARE PHARMACY
City	:	ATLANTA
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:	404-851-8897
Fax Number	:	404-303-3323

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FERRY RD NE
Second Line	:	HOMECARE PHARMACY
City	:	ATLANTA
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:	404-851-8897
Fax Number	:	404-303-3323

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MRS. JUDY GARDNER
Credential	:
Telephone Number	:	404-851-6793

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/13/2015

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Directions to “NORTHSIDE HOSPITAL HOMECARE PHARMACY ” Practice Location

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