Shelly M Foster IV
Individual provider Active NPI Pharmacist · Ogema, MN
NPI 1205980331 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205980331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 115057 (MN)
- Practice address
- 40520 County Highway 34
Ogema, MN 56569-9612 - Phone
- (218) 983-6375
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115057 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 115057 | MN | Yes |
Addresses
Primary practice location
40520 County Highway 34
Ogema, MN 56569-9612
Mailing address
PO Box 134
Detroit Lakes, MN 56502-0134
Phone (218) 766-2864
Other providers in Ogema, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.