Healthcare Provider Details

I. General information

NPI: 1083536627
Provider Name (Legal Business Name): FOREST FAMILY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4581 HIGHWAY 80 STE A
MORTON MS
39117-3432
US

IV. Provider business mailing address

4581 HIGHWAY 80 STE A
MORTON MS
39117-3432
US

V. Phone/Fax

Practice location:
  • Phone: 601-382-8579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CALESTA HOUCHEN
Title or Position: PROVIDER ENROLLMENT LEAD
Credential:
Phone: 601-469-3151