MEDICARE: FOREST LAKE PHARMACY

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	333600000X	Pharmacy	11495	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508846056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST LAKE PHARMACY

Provider Business Mailing Address
First Line	:	9129 MESA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-1606
Country	:	US
Telephone Number	:	713-635-1441
Fax Number	:	713-635-6810

Provider Business Practice Location Address
First Line	:	9129 MESA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-1606
Country	:	US
Telephone Number	:	713-635-1441
Fax Number	:	713-635-6810

Authorized Official
Title or Position	:	CHIEF PHARMACIST
Name	:	MR. FRANCIS CHAN
Credential	:	R.PH.
Telephone Number	:	713-635-1441

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	11/18/2008

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Directions to “FOREST LAKE PHARMACY ” Practice Location

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