Provider Demographics
NPI:1497350334
Name:FOSTER, STEPHEN ERVIN SR
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ERVIN
Last Name:FOSTER
Suffix:SR
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 1:27 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1518
Mailing Address - Country:US
Mailing Address - Phone:215-828-5897
Mailing Address - Fax:
Practice Address - Street 1:3780 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-2108
Practice Address - Country:US
Practice Address - Phone:215-508-3607
Practice Address - Fax:215-508-9021
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029817L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy