MEDICARE: FORSHEE- CARDER PHARMACY, INC

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	3336H0001X	Home Infusion Therapy Pharmacy	2933	TN
2	3336L0003X	Long Term Care Pharmacy	2933	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4429684	OTHER		NCPDP ID NUMBER

General Provider Information

NPI Number	:	1316088289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORSHEE- CARDER PHARMACY, INC

Provider Business Mailing Address
First Line	:	1690 25TH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3613
Country	:	US
Telephone Number	:	423-559-3013
Fax Number	:	423-559-3007

Provider Business Practice Location Address
First Line	:	1690 25TH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3613
Country	:	US
Telephone Number	:	423-559-3013
Fax Number	:	423-559-3007

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. GRADY MICHAEL CARDER
Credential	:	RPH
Telephone Number	:	423-559-3013

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/14/2015

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