Provider Demographics
NPI:1033432661
Name:FOSS, DAVID FRANK (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FRANK
Last Name:FOSS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 OAK TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-3425
Mailing Address - Country:US
Mailing Address - Phone:507-381-8801
Mailing Address - Fax:
Practice Address - Street 1:160 NORTH MAIN STREET
Practice Address - Street 2:TUBA CITY REGIONAL HEALTH CARE CORPORATION
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2755
Practice Address - Fax:928-283-2758
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011203183500000X
WAPH60028501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist