Provider Demographics
NPI:1215054093
Name:FOSTER, KEITH A (RPH)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3655
Mailing Address - Country:US
Mailing Address - Phone:304-255-4292
Mailing Address - Fax:
Practice Address - Street 1:2810 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5238
Practice Address - Country:US
Practice Address - Phone:304-252-5305
Practice Address - Fax:304-253-4281
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist