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General NPI Number Information
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NPI Number | 1053712448
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Entity Type | Individual
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Provider Name | ABIGAIL FISH
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Gender | Female
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 301 NORTHWYND CIR APT 909
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City | LYNCHBURG
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State | VA
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Zip | 24502-3443
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Country | US
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Telephone | 616-745-2033
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Fax |
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Provider Business Mailing Address
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Address Line | 301 NORTHWYND CIR APT 909
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City | LYNCHBURG
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State | VA
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Zip | 24502-3443
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Country | US
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Telephone | 616-745-2033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202213216
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302039890
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License Number State | MI
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