Healthcare Provider Details

I. General information

NPI: 1124012463
Provider Name (Legal Business Name): FOSTER ALBERT HOTARD JR. PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TUTTLE ARMY HEALTH CLINIC PHARMACY 230 DUNCAN DRIVE BLDG 1440
HAAF GA
31408-5102
US

IV. Provider business mailing address

150 GREENBRIAR CT
SAVANNAH GA
31419-2966
US

V. Phone/Fax

Practice location:
  • Phone: 912-692-8710
  • Fax:
Mailing address:
  • Phone: 912-925-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: