Provider Demographics
NPI:1457991127
Name:FOSTER, SUSAN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 HILLMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3857
Mailing Address - Country:US
Mailing Address - Phone:903-239-1466
Mailing Address - Fax:
Practice Address - Street 1:1606 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3857
Practice Address - Country:US
Practice Address - Phone:903-239-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist