MEDICARE: MRS. PAMELA FOSTER

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	183500000X	Pharmacist	051-034057	IL

General Provider Information

NPI Number	:	1497024822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA FOSTER

Provider Business Mailing Address
First Line	:	4742 S KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 W RANDOLPH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-1812
Country	:	US
Telephone Number	:	312-263-7499
Fax Number	:	312-263-5228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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