Provider Demographics
NPI:1417323528
Name:FOSTER, DORIAN MERCEDES (RPH)
Entity Type:Individual
Prefix:MS
First Name:DORIAN
Middle Name:MERCEDES
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:DORIAN
Other - Middle Name:MERCEDES
Other - Last Name:HOLLINGWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:900 W DEUCE OF CLUBS
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-6214
Mailing Address - Country:US
Mailing Address - Phone:928-532-5659
Mailing Address - Fax:
Practice Address - Street 1:900 W DEUCE OF CLUBS
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-6214
Practice Address - Country:US
Practice Address - Phone:928-532-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021101183500000X
NY043807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist