Provider Demographics
NPI:1134112816
Name:FOSTER, SAMUEL LOREN (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:LOREN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:25519 STATE HIGHWAY 224
Mailing Address - Street 2:PHS INDIAN HEALTH CENTER
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569-9506
Mailing Address - Country:US
Mailing Address - Phone:218-983-6374
Mailing Address - Fax:218-983-6384
Practice Address - Street 1:25519 STATE HIGHWAY 224
Practice Address - Street 2:PHS INDIAN HEALTH CENTER
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569-9506
Practice Address - Country:US
Practice Address - Phone:218-983-6374
Practice Address - Fax:218-983-6384
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN115015-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist