MEDICARE: DR. NICHOLAS T FISHER PHARMD

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	0202213452	VA

General Provider Information

NPI Number	:	1629671268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS T FISHER PHARMD

Provider Business Mailing Address
First Line	:	132 SUNRISE DR
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-1600
Country	:	US
Telephone Number	:	143-466-5666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 GENERAL BOOTH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3907
Country	:	US
Telephone Number	:	757-430-2981
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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