Healthcare Provider Details

I. General information

NPI: 1518047398
Provider Name (Legal Business Name): FORREST C GREEN III PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 FOREST DR KROGER PHARMACY
COLUMBIA SC
29204-4028
US

IV. Provider business mailing address

1016 REED CT
LEXINGTON SC
29072
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-4027
  • Fax: 803-738-2415
Mailing address:
  • Phone: 803-358-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10958
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: