Provider Demographics
NPI:1760530992
Name:FOSTER, WAYNE HOWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:HOWARD
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 1:40 IKE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-8315
Mailing Address - Country:US
Mailing Address - Phone:814-692-1050
Mailing Address - Fax:814-466-7825
Practice Address - Street 1:3901 S ATHERTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-466-7936
Practice Address - Fax:814-466-7825
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029469L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist