Healthcare Provider Details

I. General information

NPI: 1679291025
Provider Name (Legal Business Name): HEATHER FOSTER PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4595 HIGHWAY 92
ACWORTH GA
30102-2233
US

IV. Provider business mailing address

4000 DUNWOODY PARK APT 5403
DUNWOODY GA
30338-7968
US

V. Phone/Fax

Practice location:
  • Phone: 770-529-9712
  • Fax:
Mailing address:
  • Phone: 478-283-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH033830
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: