MEDICARE: FOREST FAMILY PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1174211320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST FAMILY PHARMACY, LLC

Provider Business Mailing Address
First Line	:	505 AIRPORT RD STE A
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-4033
Country	:	US
Telephone Number	:	601-469-4151
Fax Number	:	601-469-9927

Provider Business Practice Location Address
First Line	:	505 AIRPORT RD STE A
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-4033
Country	:	US
Telephone Number	:	601-333-6337
Fax Number	:	601-333-0985

Authorized Official
Title or Position	:	COB
Name	:	JOHN LEE
Credential	:	MD
Telephone Number	:	601-469-4151

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	06/05/2023

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Directions to “FOREST FAMILY PHARMACY, LLC ” Practice Location

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