Healthcare Provider Details

I. General information

NPI: 1629985486
Provider Name (Legal Business Name): DEREK FISHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 GRAND AVE
BILLINGS MT
59102-8134
US

IV. Provider business mailing address

3137 GRAND AVE
BILLINGS MT
59102-8134
US

V. Phone/Fax

Practice location:
  • Phone: 406-652-8359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-127417
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: