MEDICARE: MRS. SUSAN LYNN FISHER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26015333A	IN

General Provider Information

NPI Number	:	1134619026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN LYNN FISHER RPH

Provider Business Mailing Address
First Line	:	106 S COLUMBIA ST
Second Line	:
City	:	UNION CITY
State	:	IN
Zip	:	47390-1434
Country	:	US
Telephone Number	:	765-964-6000
Fax Number	:	765-964-6017

Provider Business Practice Location Address
First Line	:	106 S COLUMBIA ST
Second Line	:
City	:	UNION CITY
State	:	IN
Zip	:	47390-1434
Country	:	US
Telephone Number	:	765-964-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	05/16/2018

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