MEDICARE: DR. CARRIE LOUISE FISH PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	03-2-26376	OH

General Provider Information

NPI Number	:	1811993132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE LOUISE FISH PHARM.D.

Provider Business Mailing Address
First Line	:	7673 FOXBORO LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1804
Country	:	US
Telephone Number	:	614-218-7237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 DELAWARE AVE
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6416
Country	:	US
Telephone Number	:	740-383-7022
Fax Number	:	740-383-7019

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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