Provider Demographics
NPI:1942617121
Name:FOSTER, ROBERT GRAY (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GRAY
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 1:1260 E SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3408
Mailing Address - Country:US
Mailing Address - Phone:417-895-3110
Mailing Address - Fax:417-895-3104
Practice Address - Street 1:1260 E SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3408
Practice Address - Country:US
Practice Address - Phone:417-895-3110
Practice Address - Fax:417-895-3104
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000173539183500000X
FLPS20897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist