Provider Demographics
NPI:1639685530
Name:FOSTER, KELLY LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LEE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5407 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-4412
Mailing Address - Country:US
Mailing Address - Phone:931-451-7785
Mailing Address - Fax:931-451-7786
Practice Address - Street 1:5407 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-4412
Practice Address - Country:US
Practice Address - Phone:931-451-7785
Practice Address - Fax:931-451-7786
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist