Provider Demographics
NPI:1629437041
Name:FISHER, NICOLE M (PHARM-D)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:FISHER
Suffix:
Gender:F
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 1:966 E IREDELL AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2432
Mailing Address - Country:US
Mailing Address - Phone:704-360-6118
Mailing Address - Fax:704-360-6117
Practice Address - Street 1:966 E IREDELL AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2432
Practice Address - Country:US
Practice Address - Phone:704-360-6118
Practice Address - Fax:704-360-6117
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3706183500000X
NC25583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist