Provider Demographics
NPI:1770860140
Name:FISHER, MARY SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14348 MURPHY CIR W
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-1101
Mailing Address - Country:US
Mailing Address - Phone:336-662-3308
Mailing Address - Fax:
Practice Address - Street 1:14348 MURPHY CIR W
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-1101
Practice Address - Country:US
Practice Address - Phone:336-662-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021955A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist