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General NPI Number Information
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NPI Number | 1477754463
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Entity Type | Organization
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Legal Business Name | FOSTER CORNER DRUG INC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 04/08/2013
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Provider Practice Location Address
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Address Line | 328 N 6TH ST
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City | PERRY
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State | OK
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Zip | 73077-6607
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Country | US
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Telephone | 580-336-2136
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Fax |
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Provider Business Mailing Address
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Address Line | 328 N 6TH ST
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City | PERRY
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State | OK
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Zip | 73077-6607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND PHARMACIST
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Name | TROY SIMONS
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Credential |
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Telephone | 580-336-2136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 56-1529
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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