Provider Demographics
NPI:1336758853
Name:FISHER, DESTINY HOPE (RPH)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:HOPE
Last Name:FISHER
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 1:616 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-6406
Mailing Address - Country:US
Mailing Address - Phone:570-855-0533
Mailing Address - Fax:
Practice Address - Street 1:140 CONTINENTAL BLVD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1089
Practice Address - Country:US
Practice Address - Phone:570-271-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist