NPIMap

Organization Active NPI

Express at Northside LLC

  • Community/Retail Pharmacy
  • Atlanta, GA
National Provider Identifier
1285145789
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE010415 Issued in GA
Legal business name
EXPRESS AT NORTHSIDE LLC
Doing business as
EXPRESS PHARMACY
Practice address
296 Northside Dr SW
Atlanta, GA 30313-1228
Phone
(404) 549-7762
Fax
(404) 549-7625
NPI assigned
Oct 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ketan TrivediNPI 1164947123
Title
Member
Phone
(678) 205-7038

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE010415 GA Primary
Compounding Pharmacy 3336C0004X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

296 Northside Dr SW
Atlanta, GA 30313-1228

Mailing address

296 Northside Dr SW
Atlanta, GA 30313-1228
Phone (404) 549-7762

Other identifiers 2

IdentifierTypeStateIssuer
003199602AMedicaidGA
2172400OtherPK

Other names 1

  • EXPRESS PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

296 Northside Dr SW
Atlanta, GA 30313
Phone (404) 549-7762

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1285145789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 NORTHSIDE DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303131228",
            "telephone_number": "404-549-7762",
            "fax_number": "404-549-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 NORTHSIDE DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303131228",
            "telephone_number": "404-549-7762",
            "fax_number": "404-549-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESS AT NORTHSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-24",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "TRIVEDI",
        "authorized_official_first_name": "KETAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "678-205-7038"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010415",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003199602A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2172400",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EXPRESS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.