Provider Demographics
NPI:1093833105
Name:FOSTER HOLDINGS LTD
Entity Type:Organization
Organization Name:FOSTER HOLDINGS LTD
Other - Org Name:WELL LIFE SAND CREEK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-290-5362
Mailing Address - Street 1:476864 HIGHWAY 95
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852-5000
Mailing Address - Country:US
Mailing Address - Phone:208-265-0142
Mailing Address - Fax:208-265-0185
Practice Address - Street 1:476864 HWY 95 N
Practice Address - Street 2:STE 3
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9737
Practice Address - Country:US
Practice Address - Phone:208-265-0142
Practice Address - Fax:208-265-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2152CP333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807709100Medicaid
1307760OtherOTHER ID NUMBER
4305540002Medicare NSC