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General NPI Number Information
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NPI Number | 1518047398
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Entity Type | Individual
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Provider Name | FORREST C GREEN III PHARM D
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 3403 FOREST DR KROGER PHARMACY
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City | COLUMBIA
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State | SC
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Zip | 29204-4028
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Country | US
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Telephone | 803-782-4027
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Fax | 803-738-2415
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Provider Business Mailing Address
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Address Line | 1016 REED CT
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City | LEXINGTON
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State | SC
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Zip | 29072
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Country | US
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Telephone | 803-358-9310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10958
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License Number State | SC
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