Provider Demographics
NPI:1518047398
Name:GREEN, FORREST C III (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:FORREST
Middle Name:C
Last Name:GREEN
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 REED CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-358-9310
Mailing Address - Fax:
Practice Address - Street 1:3403 FOREST DR
Practice Address - Street 2:KROGER PHARMACY
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4028
Practice Address - Country:US
Practice Address - Phone:803-782-4027
Practice Address - Fax:803-738-2415
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist