Provider Demographics
NPI:1669766614
Name:FISHER, ADDAM (PHARMD)
Entity type:Individual
Prefix:
First Name:ADDAM
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W SUNSET DR
Mailing Address - Street 2:T-2546
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-8423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 W SUNSET DR
Practice Address - Street 2:T-2546
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-8423
Practice Address - Country:US
Practice Address - Phone:262-832-1273
Practice Address - Fax:262-832-1283
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1556-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist