Provider Demographics
NPI:1720512452
Name:FISHER, CRAIG THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:THOMAS
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 1:623 W SURF ST APT GW
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5388
Mailing Address - Country:US
Mailing Address - Phone:317-682-8928
Mailing Address - Fax:
Practice Address - Street 1:940 S FRONTAGE RD
Practice Address - Street 2:SUITE 1900
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4946
Practice Address - Country:US
Practice Address - Phone:630-985-7189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist