Provider Demographics
NPI:1225157613
Name:FISHER, RONALD THOMAS (RPH, CDM)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:THOMAS
Last Name:FISHER
Suffix:
Gender:M
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 59TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3528
Mailing Address - Country:US
Mailing Address - Phone:941-753-1577
Mailing Address - Fax:941-795-5385
Practice Address - Street 1:7400 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2407
Practice Address - Country:US
Practice Address - Phone:941-795-5185
Practice Address - Fax:941-795-5385
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist