Healthcare Provider Details

I. General information

NPI: 1104805456
Provider Name (Legal Business Name): LINDA L FORREST RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 REMEMBRANCE RD NW
WALKER MI
49534-7744
US

IV. Provider business mailing address

358 GLENWOODS CT NE
ROCKFORD MI
49341-1508
US

V. Phone/Fax

Practice location:
  • Phone: 616-791-0383
  • Fax:
Mailing address:
  • Phone: 616-791-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411295
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: