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General NPI Number Information
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NPI Number | 1083536627
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Entity Type | Organization
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Legal Business Name | FOREST FAMILY PHARMACY, LLC
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 4581 HIGHWAY 80 STE A
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City | MORTON
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State | MS
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Zip | 39117-3432
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Country | US
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Telephone | 601-382-8579
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Fax |
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Provider Business Mailing Address
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Address Line | 4581 HIGHWAY 80 STE A
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City | MORTON
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State | MS
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Zip | 39117-3432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT LEAD
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Name | CALESTA HOUCHEN
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Credential |
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Telephone | 601-469-3151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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