Healthcare Provider Details

I. General information

NPI: 1427669506
Provider Name (Legal Business Name): KYLE CHRISTOPHER FISCHER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SAN PABLO ST STE 144
LOS ANGELES CA
90033-5394
US

IV. Provider business mailing address

12447 SILVER SADDLE DR
RANCHO CUCAMONGA CA
91739-9520
US

V. Phone/Fax

Practice location:
  • Phone: 909-635-5145
  • Fax:
Mailing address:
  • Phone: 909-635-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: