Provider Demographics
NPI:1750335303
Name:FOREST HILLSPHARMACY
Entity type:Organization
Organization Name:FOREST HILLSPHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-949-0240
Mailing Address - Street 1:4668 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3718
Mailing Address - Country:US
Mailing Address - Phone:616-949-1520
Mailing Address - Fax:616-949-4073
Practice Address - Street 1:4668 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3718
Practice Address - Country:US
Practice Address - Phone:616-949-1520
Practice Address - Fax:616-949-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010064243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301006424OtherPHARMACY LICENSE
MI2321177OtherNCPDP