Healthcare Provider Details

I. General information

NPI: 1457646630
Provider Name (Legal Business Name): MICHELLE ANN FORRESTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3489 LOWERY PKWY T-2355
FULTONDALE AL
35068-1677
US

IV. Provider business mailing address

3489 LOWERY PKWY T-2355
FULTONDALE AL
35068-1677
US

V. Phone/Fax

Practice location:
  • Phone: 205-453-6033
  • Fax: 205-453-6033
Mailing address:
  • Phone: 205-453-6033
  • Fax: 205-453-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16075
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: