Provider Demographics
NPI:1003624289
Name:FAITHCARE PHARMACY
Entity type:Organization
Organization Name:FAITHCARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:AN
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-309-2137
Mailing Address - Street 1:10266 N 2126 RD
Mailing Address - Street 2:
Mailing Address - City:FOSS
Mailing Address - State:OK
Mailing Address - Zip Code:73647-4772
Mailing Address - Country:US
Mailing Address - Phone:580-562-3629
Mailing Address - Fax:
Practice Address - Street 1:220 OK- 44
Practice Address - Street 2:
Practice Address - City:BURNS FLAT
Practice Address - State:OK
Practice Address - Zip Code:73647
Practice Address - Country:US
Practice Address - Phone:580-562-3629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK33-9816OtherOKLAHOMA STATE BOARD OF PHARMACY