MEDICARE: DR. LAURA R 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	183500000X	Pharmacist	2001025353	MO

General Provider Information

NPI Number	:	1871831644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA R FISH PHARM.D.

Provider Business Mailing Address
First Line	:	5330 NW 64TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 NW 64TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2414
Country	:	US
Telephone Number	:	816-505-7163
Fax Number	:

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

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	01/29/2013

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