Provider Demographics
NPI:1952744427
Name:FOSTER, ZINA ZONELL (RPH)
Entity Type:Individual
Prefix:
First Name:ZINA
Middle Name:ZONELL
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 1:195 HERITAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4373
Mailing Address - Country:US
Mailing Address - Phone:678-817-5916
Mailing Address - Fax:
Practice Address - Street 1:195 HERITAGE LAKE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4373
Practice Address - Country:US
Practice Address - Phone:678-817-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist