Provider Demographics
NPI:1972060911
Name:FOSTER, ROSS (DPH)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 W GARY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-5302
Mailing Address - Country:US
Mailing Address - Phone:580-323-1136
Mailing Address - Fax:
Practice Address - Street 1:2008 W GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-5302
Practice Address - Country:US
Practice Address - Phone:580-323-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist