Provider Demographics
NPI:1932495587
Name:FISKE, PAMELA (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:FISKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 GEORGE WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4293
Mailing Address - Country:US
Mailing Address - Phone:401-642-0081
Mailing Address - Fax:401-642-0911
Practice Address - Street 1:620 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4293
Practice Address - Country:US
Practice Address - Phone:401-642-0081
Practice Address - Fax:401-642-0911
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH03326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist