Provider Demographics
NPI:1033230982
Name:FOREST HILL PHARMACY LLC
Entity Type:Organization
Organization Name:FOREST HILL PHARMACY LLC
Other - Org Name:FOREST HILL PHARMACY, MEDICINE SHOPPE 2061
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-543-4440
Mailing Address - Street 1:2939 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5962
Mailing Address - Country:US
Mailing Address - Phone:561-965-4288
Mailing Address - Fax:561-965-1787
Practice Address - Street 1:2939 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5962
Practice Address - Country:US
Practice Address - Phone:561-965-4288
Practice Address - Fax:561-965-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH282183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014587400Medicaid
2151318OtherPK
I02351OtherPCS