Provider Demographics
NPI:1629671268
Name:FISHER, NICHOLAS T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:T
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1600
Mailing Address - Country:US
Mailing Address - Phone:143-466-5666
Mailing Address - Fax:
Practice Address - Street 1:2232 GENERAL BOOTH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3907
Practice Address - Country:US
Practice Address - Phone:757-430-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist