Provider Demographics
NPI:1477703072
Name:FOSTER, JOHN BRENT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRENT
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:CHILHOWIE
Mailing Address - State:VA
Mailing Address - Zip Code:24319-0556
Mailing Address - Country:US
Mailing Address - Phone:276-646-3512
Mailing Address - Fax:276-646-2342
Practice Address - Street 1:106 WEST LEE HWY
Practice Address - Street 2:
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319-0556
Practice Address - Country:US
Practice Address - Phone:276-646-3512
Practice Address - Fax:276-646-2342
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist