Provider Demographics
NPI:1477322865
Name:FISCH, TYLER JACOB (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JACOB
Last Name:FISCH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ENGLISH SADDLE CT
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9089
Mailing Address - Country:US
Mailing Address - Phone:443-844-4363
Mailing Address - Fax:
Practice Address - Street 1:200 MALCOLM DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6110
Practice Address - Country:US
Practice Address - Phone:410-848-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist