Provider Demographics
NPI:1427544139
Name:FISH, DOUGLAS NORMAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:NORMAN
Last Name:FISH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6552 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2711
Mailing Address - Country:US
Mailing Address - Phone:303-724-2615
Mailing Address - Fax:303-724-0979
Practice Address - Street 1:6552 STARLIGHT DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2711
Practice Address - Country:US
Practice Address - Phone:303-724-2615
Practice Address - Fax:303-724-0979
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO136961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist