Provider Demographics
NPI:1679669626
Name:FOSTER, MANDY LYNN (CPHT)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 COUNTY ST
Mailing Address - Street 2:APT. A
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-0060
Mailing Address - Country:US
Mailing Address - Phone:734-439-2101
Mailing Address - Fax:
Practice Address - Street 1:1015 DEXTER ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1158
Practice Address - Country:US
Practice Address - Phone:734-439-8877
Practice Address - Fax:734-439-0010
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3101-0105-0354-015183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician