Provider Demographics
NPI:1417062696
Name:FISHER, STACEY B (RPH)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:B
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 1:317 MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127
Mailing Address - Country:US
Mailing Address - Phone:540-864-8800
Mailing Address - Fax:540-864-8803
Practice Address - Street 1:317 MARKET ST.
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127
Practice Address - Country:US
Practice Address - Phone:540-864-8800
Practice Address - Fax:540-864-8803
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist