Provider Demographics
NPI:1215206412
Name:FISHER, JASON GUSTAVE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GUSTAVE
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N SUMTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-8073
Mailing Address - Country:US
Mailing Address - Phone:941-426-5083
Mailing Address - Fax:
Practice Address - Street 1:1009 N SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8073
Practice Address - Country:US
Practice Address - Phone:941-426-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist