Provider Demographics
NPI:1518623420
Name:FISH, THOMAS BALMAT (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BALMAT
Last Name:FISH
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 1:2162 SEBASTIAN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-5736
Mailing Address - Country:US
Mailing Address - Phone:540-207-9476
Mailing Address - Fax:540-322-4898
Practice Address - Street 1:2281 CARL D SILVER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4983
Practice Address - Country:US
Practice Address - Phone:540-322-4845
Practice Address - Fax:540-322-4846
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202005935OtherPHARMACIST LICENSE NUMBER