Healthcare Provider Details

I. General information

NPI: 1992527972
Provider Name (Legal Business Name): FOSTER SPECIALTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 N 6TH ST
PERRY OK
73077
US

IV. Provider business mailing address

328 N 6TH ST
PERRY OK
73077
US

V. Phone/Fax

Practice location:
  • Phone: 580-336-2136
  • Fax: 580-336-9445
Mailing address:
  • Phone: 580-336-2136
  • Fax: 580-336-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TROY SIMONS
Title or Position: PRESIDENT
Credential:
Phone: 405-742-8099