Provider Demographics
NPI:1932347499
Name:FORSTER, KIM EDWARD (RPH)
Entity type:Individual
Prefix:MR
First Name:KIM
Middle Name:EDWARD
Last Name:FORSTER
Suffix:
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:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:CENTRAL LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49622-0425
Mailing Address - Country:US
Mailing Address - Phone:231-544-2929
Mailing Address - Fax:231-544-5408
Practice Address - Street 1:2424 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRAL LAKE
Practice Address - State:MI
Practice Address - Zip Code:49622-9271
Practice Address - Country:US
Practice Address - Phone:231-544-2929
Practice Address - Fax:231-544-5408
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist