Healthcare Provider Details

I. General information

NPI: 1427544139
Provider Name (Legal Business Name): DOUGLAS NORMAN FISH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6552 STARLIGHT DR
MORRISON CO
80465-2711
US

IV. Provider business mailing address

6552 STARLIGHT DR
MORRISON CO
80465-2711
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-2615
  • Fax: 303-724-0979
Mailing address:
  • Phone: 303-724-2615
  • Fax: 303-724-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number13696
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: