# FOSTER CORNER DRUG LONG TERM CARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Foster Corner Drug Long Term Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093362337
- **Authorized official:** TROY SIMONS (PRESIDENT)
- **Authorized official phone:** (405) 372-4882

## Contact information

- **Practice address:** 328 N 6TH ST, PERRY, OK 73077-6607
- **Practice address phone:** (580) 336-2136
- **Practice address fax:** (580) 336-9445
- **Mailing address:** 328 N 6TH ST, PERRY, OK 73077-6607
- **Mailing address phone:** (580) 336-2136
- **Mailing address fax:** (580) 336-9445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/21/2019
- **Last updated:** 10/19/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100232570A | — | OK |