Provider Demographics
NPI:1578293668
Name:FOSTER, MARY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2116 TANGLEWOOD BLVD LOT A1001
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-4855
Mailing Address - Country:US
Mailing Address - Phone:903-415-0456
Mailing Address - Fax:
Practice Address - Street 1:200 W CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4604
Practice Address - Country:US
Practice Address - Phone:190-346-5618
Practice Address - Fax:903-463-4772
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist