Provider Demographics
NPI:1396937520
Name:FISH, STUART LAWRENCE (RPH)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:LAWRENCE
Last Name:FISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:29 BALMORAL CRES
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2201
Mailing Address - Country:US
Mailing Address - Phone:914-592-6399
Mailing Address - Fax:914-457-6203
Practice Address - Street 1:29 BALMORAL CRES
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-2201
Practice Address - Country:US
Practice Address - Phone:914-592-6399
Practice Address - Fax:914-457-6203
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist