Healthcare Provider Details

I. General information

NPI: 1568537876
Provider Name (Legal Business Name): DIANE MARY FISCHER R.PH. CPG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 S LAKE BLVD SUITE 6
MAHOPAC NY
10541-3218
US

IV. Provider business mailing address

935 S LAKE BLVD SUITE 6
MAHOPAC NY
10541-3218
US

V. Phone/Fax

Practice location:
  • Phone: 845-208-3328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number034688-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: