Provider Demographics
NPI:1588814594
Name:FISHER, PHESHETTA SHAREE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHESHETTA
Middle Name:SHAREE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:PHESHETTA
Other - Middle Name:SHAREE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9805 ROCKY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8922
Mailing Address - Country:US
Mailing Address - Phone:704-494-3466
Mailing Address - Fax:
Practice Address - Street 1:9805 ROCKY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8922
Practice Address - Country:US
Practice Address - Phone:704-494-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist