Provider Demographics
NPI:1265420624
Name:FISCHER, ROBERT NATHANIEL (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:NATHANIEL
Last Name:FISCHER
Suffix:
Gender:M
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:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-0114
Mailing Address - Country:US
Mailing Address - Phone:208-452-4758
Mailing Address - Fax:
Practice Address - Street 1:293 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4530
Practice Address - Country:US
Practice Address - Phone:541-881-1213
Practice Address - Fax:541-881-0032
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist