Healthcare Provider Details

I. General information

NPI: 1477703072
Provider Name (Legal Business Name): JOHN BRENT FOSTER PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 WEST LEE HWY
CHILHOWIE VA
24319-0556
US

IV. Provider business mailing address

PO BOX 556
CHILHOWIE VA
24319-0556
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-3512
  • Fax: 276-646-2342
Mailing address:
  • Phone: 276-646-3512
  • Fax: 276-646-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202006608
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: