1124012463 NPI number — MR. FOSTER ALBERT HOTARD JR. PHARMACIST

Table of content: MR. FOSTER ALBERT HOTARD JR. PHARMACIST (NPI 1124012463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124012463 NPI number — MR. FOSTER ALBERT HOTARD JR. PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOTARD
Provider First Name:
FOSTER
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124012463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 GREENBRIAR CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31419-2966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-925-0210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TUTTLE ARMY HEALTH CLINIC PHARMACY
Provider Second Line Business Practice Location Address:
230 DUNCAN DRIVE BLDG 1440
Provider Business Practice Location Address City Name:
HAAF
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31408-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-692-8710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  11701 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)