Provider Demographics
NPI:1437754421
Name:FISHER, SAMUEL C (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:C
Last Name:FISHER
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 1:1062 BROOK RUN RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-3003
Mailing Address - Country:US
Mailing Address - Phone:434-470-0153
Mailing Address - Fax:
Practice Address - Street 1:3231 HALIFAX RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4907
Practice Address - Country:US
Practice Address - Phone:434-572-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist