Provider Demographics
NPI:1821096314
Name:FOSTERS PHARMACY, INC.
Entity Type:Organization
Organization Name:FOSTERS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-392-0911
Mailing Address - Street 1:207 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2427
Mailing Address - Country:US
Mailing Address - Phone:740-392-0911
Mailing Address - Fax:740-392-0960
Practice Address - Street 1:207 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2427
Practice Address - Country:US
Practice Address - Phone:740-392-0911
Practice Address - Fax:740-392-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH42018617332B00000X
OH0201796003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0471127Medicaid
OH3610222OtherNABP
OH3610222OtherNABP
OH0221790001Medicare NSC