MEDICARE: STEPHEN ERVIN FOSTER SR.

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	RP029817L	PA

General Provider Information

NPI Number	:	1497350334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN ERVIN FOSTER SR.

Provider Business Mailing Address
First Line	:	27 WALNUT ST
Second Line	:
City	:	MORTON
State	:	PA
Zip	:	19070-1518
Country	:	US
Telephone Number	:	215-828-5897
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 MAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2108
Country	:	US
Telephone Number	:	215-508-3607
Fax Number	:	215-508-9021

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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