Healthcare Provider Details

I. General information

NPI: 1003305475
Provider Name (Legal Business Name): DIANE FORBUS PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 POWELL AVE
NASHVILLE TN
37204-4653
US

IV. Provider business mailing address

4415 BETTS RD
GREENBRIER TN
37073-4993
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-3814
  • Fax: 615-383-3814
Mailing address:
  • Phone: 615-522-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number4675
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: