Provider Demographics
NPI:1720061989
Name:PINEVIEW PHARMACY INC
Entity type:Organization
Organization Name:PINEVIEW PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACISTS/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FOREHAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-624-2711
Mailing Address - Street 1:117 COMMERCE ST E
Mailing Address - Street 2:
Mailing Address - City:PINEVIEW
Mailing Address - State:GA
Mailing Address - Zip Code:31071-3437
Mailing Address - Country:US
Mailing Address - Phone:229-624-2711
Mailing Address - Fax:229-624-2811
Practice Address - Street 1:117 COMMERCE ST E
Practice Address - Street 2:
Practice Address - City:PINEVIEW
Practice Address - State:GA
Practice Address - Zip Code:31071-3437
Practice Address - Country:US
Practice Address - Phone:229-624-2711
Practice Address - Fax:229-624-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00436576AMedicaid
GA1112983Medicare UPIN
GA00436576AMedicaid