Healthcare Provider Details

I. General information

NPI: 1316088289
Provider Name (Legal Business Name): FORSHEE- CARDER PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 25TH ST NW
CLEVELAND TN
37311-3613
US

IV. Provider business mailing address

1690 25TH ST NW
CLEVELAND TN
37311-3613
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-3013
  • Fax: 423-559-3007
Mailing address:
  • Phone: 423-559-3013
  • Fax: 423-559-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number2933
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2933
License Number StateTN

VIII. Authorized Official

Name: MR. GRADY MICHAEL CARDER
Title or Position: VICE-PRESIDENT
Credential: RPH
Phone: 423-559-3013