MEDICARE: FOSTER'S SUPER MARKETS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225188485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOSTER'S SUPER MARKETS, INC

Provider Business Mailing Address
First Line	:	PO BOX 430
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-0430
Country	:	US
Telephone Number	:	231-839-5800
Fax Number	:	231-839-2206

Provider Business Practice Location Address
First Line	:	5760 WEST HOUGHTON LAKE ROAD
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-0430
Country	:	US
Telephone Number	:	231-839-5800
Fax Number	:	231-839-2206

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	VINH TRAN
Credential	:
Telephone Number	:	231-839-5800

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	10/20/2017

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Directions to “FOSTER'S SUPER MARKETS, INC ” Practice Location

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