Provider Demographics
NPI:1093161846
Name:FOSTER, JEFFREY LYNN
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:FOSTER
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 1:24271 MUIRLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3001
Mailing Address - Country:US
Mailing Address - Phone:949-472-6016
Mailing Address - Fax:949-472-8603
Practice Address - Street 1:24271 MUIRLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3001
Practice Address - Country:US
Practice Address - Phone:949-472-6016
Practice Address - Fax:949-472-8603
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist