Provider Demographics
NPI:1013575810
Name:FOSTER, MICHELLE D (DPH)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPH
Mailing Address - Street 1:3414 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5071
Mailing Address - Country:US
Mailing Address - Phone:918-682-7765
Mailing Address - Fax:918-682-7772
Practice Address - Street 1:3414 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5071
Practice Address - Country:US
Practice Address - Phone:918-682-7765
Practice Address - Fax:918-682-7772
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU080927068OtherOKLAHOMA DRIVER LICENSE