Healthcare Provider Details

I. General information

NPI: 1154627974
Provider Name (Legal Business Name): ANDREW MICHAEL FOSTER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 06/22/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US-491
SHIPROCK NM
87420
US

IV. Provider business mailing address

US-491
SHIPROCK NM
87420
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16363
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: