Canton Northside Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

002901 Issued in GA

Legal business name

CANTON NORTHSIDE PHARMACY INC

Doing business as

Canton Northside Pharmacy

Practice address

170 Marietta Hwy
Canton, GA 30114-2303

Phone

(770) 479-2171

Fax

(770) 720-6006

NPI assigned

Jul 21, 2005

Last updated

Sep 19, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Darrell ChesterNPI 1700473287

Title

Pres

Phone

(770) 479-2171

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• CANTON NORTHSIDE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Canton Northside Pharmacy Inc

  dba Northside Pharmacy Waleska

  • Community/Retail Pharmacy
  • Waleska, GA
  • NPI 1528257102

  1456471721

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Canton Northside Pharmacy Inc

  dba Northside Pharmacy Waleska

  • Community/Retail Pharmacy
  • Waleska, GA
  • NPI 1528257102

  O20111020000599

  Same enrollment

Tax ID family

Canton Northside Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Canton Northside Pharmacy Inc

  dba Northside Pharmacy Waleska

  • Community/Retail Pharmacy
  • Waleska, GA
  • NPI 1528257102
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Darrell Chester, RPH

  • Pharmacist
  • Canton, GA
  • NPI 1700473287
  NPD (past) Authorized official
• Robert Bagwell Jr., PHARMD

  • Pharmacist
  • Canton, GA
  • NPI 1114514684
  NPD
• Phillip Taylor, RPH

  • Pharmacist
  • Waleska, GA
  • NPI 1609463124
  NPD (past)

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1861492761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4460",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301140200",
            "telephone_number": "770-479-2171",
            "fax_number": "770-720-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MARIETTA HWY",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142303",
            "telephone_number": "770-479-2171",
            "fax_number": "770-720-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON NORTHSIDE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "CHESTER",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "770-479-2171"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "002901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00022778A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2012090",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00022778B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CANTON NORTHSIDE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Canton Pediatric Dentistry PC
• Canton Physical Medicare, LLC

• Community/Retail Pharmacy in Canton, GA
• Providers in Canton, GA by specialty
• Community/Retail Pharmacy in Georgia

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.