Provider Demographics
NPI:1083332761
Name:FISH, MICHAELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10708 SILVER LEAF WAY APT F-203
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2754
Mailing Address - Country:US
Mailing Address - Phone:256-436-1658
Mailing Address - Fax:
Practice Address - Street 1:1602 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-6206
Practice Address - Country:US
Practice Address - Phone:865-977-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist