Provider Demographics
NPI:1255774121
Name:FOREST PHARMACY INC
Entity type:Organization
Organization Name:FOREST PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:STILTNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-613-6019
Mailing Address - Street 1:1787 W LEE HIGHWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-227-0781
Mailing Address - Fax:276-227-0791
Practice Address - Street 1:1787 W LEE HIGHWAY
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-227-0781
Practice Address - Fax:276-227-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7014150001Medicare NSC