Healthcare Provider Details

I. General information

NPI: 1750335303
Provider Name (Legal Business Name): FOREST HILLSPHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4668 CASCADE RD SE
GRAND RAPIDS MI
49546-3718
US

IV. Provider business mailing address

4668 CASCADE RD SE
GRAND RAPIDS MI
49546-3718
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-1520
  • Fax: 616-949-4073
Mailing address:
  • Phone: 616-949-1520
  • Fax: 616-949-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301006424
License Number StateMI

VIII. Authorized Official

Name: MISS LUCINDA M. WRIGHT
Title or Position: MANAGER
Credential:
Phone: 616-949-0240