Healthcare Provider Details

I. General information

NPI: 1669794210
Provider Name (Legal Business Name): JULIE FISHER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 FRANKLIN ST
MICHIGAN CITY IN
46360-7878
US

IV. Provider business mailing address

2071 E 61ST AVE
HOBART IN
46342-6823
US

V. Phone/Fax

Practice location:
  • Phone: 219-877-2410
  • Fax:
Mailing address:
  • Phone: 219-877-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020325A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: