Healthcare Provider Details

I. General information

NPI: 1104534908
Provider Name (Legal Business Name): MICHAEL FISCHER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 STILLWATER RD
WILLERNIE MN
55090
US

IV. Provider business mailing address

PO BOX 298
WILLERNIE MN
55090-0298
US

V. Phone/Fax

Practice location:
  • Phone: 651-666-2117
  • Fax: 651-666-2113
Mailing address:
  • Phone: 651-666-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118715
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: