Provider Demographics
NPI:1770958456
Name:FORRESTER, MARION THOMAS JR (RPH)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:THOMAS
Last Name:FORRESTER
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 WHITESBURG DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1690
Mailing Address - Country:US
Mailing Address - Phone:256-883-0325
Mailing Address - Fax:
Practice Address - Street 1:4906 WHITESBURG DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1690
Practice Address - Country:US
Practice Address - Phone:256-883-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist