Provider Demographics
NPI:1568764694
Name:FOSTER, BRADLEY KYLE (RPH)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KYLE
Last Name:FOSTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LAMAR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4460
Mailing Address - Country:US
Mailing Address - Phone:903-785-4208
Mailing Address - Fax:903-737-6974
Practice Address - Street 1:707 LAMAR AVE STE A
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4460
Practice Address - Country:US
Practice Address - Phone:903-785-4208
Practice Address - Fax:903-737-6974
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370781835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy