Organization
FOSTER HOLDINGS LTD
Active
Other names
WELL LIFE SAND CREEK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY FOSTER (PRESIDENT)
(208) 290-5362
Entity
Organization
Contact information
Practice address
476864 HWY 95 N, STE 3, PONDERAY, ID 83852-9737
(208) 265-0142
(208) 265-0185
Mailing address
476864 HIGHWAY 95, SUITE 3, PONDERAY, ID 83852-5000
(208) 265-0142
(208) 265-0185
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
2152CP
ID
3336C0003X
Community/Retail Pharmacy
Primary
2152CP
ID
3336C0004X
Compounding Pharmacy
2152CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1307760
OTHER ID NUMBER
—
05
—
807709100
—
ID
Enumeration date
03/27/2007
Last updated
06/24/2008
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