Provider Demographics
NPI:1386700268
Name:FOSTER DRUG OF MOCKSVILLE
Entity type:Organization
Organization Name:FOSTER DRUG OF MOCKSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-751-2141
Mailing Address - Street 1:495 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2074
Mailing Address - Country:US
Mailing Address - Phone:336-751-2141
Mailing Address - Fax:336-751-7974
Practice Address - Street 1:495 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2074
Practice Address - Country:US
Practice Address - Phone:336-751-2141
Practice Address - Fax:336-751-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2067876OtherPK
NC1386700268Medicaid
0132880001Medicare NSC