Provider Demographics
NPI:1700878030
Name:RAY FISHER PHARMACY INC
Entity Type:Organization
Organization Name:RAY FISHER PHARMACY INC
Other - Org Name:RAY FISHER PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-437-3800
Mailing Address - Street 1:6629 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3503
Mailing Address - Country:US
Mailing Address - Phone:559-437-3800
Mailing Address - Fax:559-437-3838
Practice Address - Street 1:6629 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3503
Practice Address - Country:US
Practice Address - Phone:559-437-3800
Practice Address - Fax:559-437-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY399163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2047778OtherPK
CAPHY58188Medicaid
CAPHA399160Medicaid