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NPI Code Detail

MEDICARE: NORTHSIDE HOSPITAL

MEDICARE: NORTHSIDE HOSPITAL
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
1333600000XPharmacyPHH007473GA

General Provider Information

NPI Number : 1356333868
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHSIDE HOSPITAL
Provider Business Mailing Address
First Line : 1200 NORTHSIDE FORSYTH DR
Second Line : NORTHSIDE HOSPITAL FORSYTH PHARMACY
City : CUMMING
State : GA
Zip : 30041-7659
Country : US
Telephone Number : 770-844-3290
Fax Number : 770-844-3424
Provider Business Practice Location Address
First Line : 1200 NORTHSIDE FORSYTH DR
Second Line : NORTHSIDE HOSPITAL FORSYTH PHARMACY
City : CUMMING
State : GA
Zip : 30041-7659
Country : US
Telephone Number : 770-844-3291
Fax Number : 770-844-3424
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : RAE LYNN BENTON
Credential : RPH
Telephone Number : 770-844-3291
Provider Enumeration Date : 08/19/2005
Last Update Date : 08/22/2020

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1841282472 — RAE LYNN BENTON RPH
Practice Location Address:
1200 NORTHSIDE FORSYTH DR , NORTHSIDE HOSPITAL FORSYTH PHARMACY
CUMMING, GA
30041-7659
Practice Phone: 770-844-3291
Practice Fax:

Directions to “NORTHSIDE HOSPITAL ” Practice Location

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