Provider Demographics
NPI:1073154944
Name:FISHER, QUENIE-MEI TULIAO (RPH)
Entity Type:Individual
Prefix:
First Name:QUENIE-MEI
Middle Name:TULIAO
Last Name:FISHER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9755
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-5755
Mailing Address - Country:US
Mailing Address - Phone:671-647-0347
Mailing Address - Fax:671-647-5403
Practice Address - Street 1:790 GOVERNOR CARLOS CAMACHO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-0347
Practice Address - Fax:671-647-5403
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH0153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU1619928264Medicaid