Provider Demographics
NPI:1629368832
Name:FOSKETT, RONALD TODD (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:TODD
Last Name:FOSKETT
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 1:5040 W FARRAND RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8215
Mailing Address - Country:US
Mailing Address - Phone:810-300-1918
Mailing Address - Fax:989-823-3332
Practice Address - Street 1:512 GOODRICH ST
Practice Address - Street 2:
Practice Address - City:VASSAR
Practice Address - State:MI
Practice Address - Zip Code:48768-9205
Practice Address - Country:US
Practice Address - Phone:989-823-2391
Practice Address - Fax:989-823-3332
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist