Organization
FOSTER'S SUPER MARKETS, INC
Active
Other names
Jerry's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VINH TRAN (PHARMACY MANAGER)
(231) 839-5800
Entity
Organization
Contact information
Practice address
5760 WEST HOUGHTON LAKE ROAD, LAKE CITY, MI 49651-0430
(231) 839-5800
(231) 839-2206
Mailing address
PO BOX 430, LAKE CITY, MI 49651-0430
(231) 839-5800
(231) 839-2206
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3245615
—
MI
Enumeration date
01/11/2007
Last updated
10/20/2017
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