Provider Demographics
NPI:1023391570
Name:FOERMAN, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FOERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1343
Mailing Address - Country:US
Mailing Address - Phone:260-358-0014
Mailing Address - Fax:206-356-7498
Practice Address - Street 1:1804 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1343
Practice Address - Country:US
Practice Address - Phone:260-358-0014
Practice Address - Fax:206-356-7498
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020748A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist