MEDICARE: CLINE & FORRISTER 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	332B00000X	Durable Medical Equipment & Medical Supplies		GA
2	3336C0003X	Community/Retail Pharmacy		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002957	OTHER	GA	RETAIL PHARMACY

General Provider Information

NPI Number	:	1639116429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINE & FORRISTER PHARMACY, INC

Provider Business Mailing Address
First Line	:	1 ALABAMA ST
Second Line	:	P.O. BOX 70
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-2608
Country	:	US
Telephone Number	:	706-777-3373
Fax Number	:	706-777-3374

Provider Business Practice Location Address
First Line	:	1 ALABAMA ST
Second Line	:
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-2608
Country	:	US
Telephone Number	:	706-777-3373
Fax Number	:	706-777-3374

Authorized Official
Title or Position	:	OWNER
Name	:	BOBBY DARRELL FORRISTER
Credential	:
Telephone Number	:	706-777-3373

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	02/04/2010

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