Healthcare Provider Details

I. General information

NPI: 1174211320
Provider Name (Legal Business Name): FOREST FAMILY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 AIRPORT RD STE A
FOREST MS
39074-4033
US

IV. Provider business mailing address

505 AIRPORT RD STE A
FOREST MS
39074-4033
US

V. Phone/Fax

Practice location:
  • Phone: 601-333-6337
  • Fax: 601-333-0985
Mailing address:
  • Phone: 601-469-4151
  • Fax: 601-469-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN LEE
Title or Position: COB
Credential: MD
Phone: 601-469-4151