Provider Demographics
NPI:1952883324
Name:FISHER, CARISSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SE B ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5941
Mailing Address - Country:US
Mailing Address - Phone:404-915-5969
Mailing Address - Fax:
Practice Address - Street 1:702 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72716-6209
Practice Address - Country:US
Practice Address - Phone:404-915-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist