MEDICARE: DR. TARAH FISHER 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	24505	IA

General Provider Information

NPI Number	:	1962199851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARAH FISHER PHARM D

Provider Business Mailing Address
First Line	:	32 PRAIRIE DAWN DR
Second Line	:
City	:	GENESEO
State	:	IL
Zip	:	61254-9202
Country	:	US
Telephone Number	:	309-945-6636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 E LINCOLNWAY STE M
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1780
Country	:	US
Telephone Number	:	815-632-6200
Fax Number	:

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

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	02/23/2024

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