Provider Demographics
NPI:1265852396
Name:FISCHER, WESLEY JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:JOHN
Last Name:FISCHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W. AVE J12 (APT 107)
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:312-631-5949
Mailing Address - Fax:661-277-8284
Practice Address - Street 1:30 NIGHTENGALE ROAD
Practice Address - Street 2:EDWARDS U.S. AIR FORCE BASE PHARMACY
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93524
Practice Address - Country:US
Practice Address - Phone:661-277-2052
Practice Address - Fax:661-277-8284
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.040338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist