Provider Demographics
NPI:1194007005
Name:FISHER, ANDREW K (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
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 1:5941 PITTSBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-4015
Mailing Address - Country:US
Mailing Address - Phone:609-457-7088
Mailing Address - Fax:
Practice Address - Street 1:2902 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8040
Practice Address - Country:US
Practice Address - Phone:757-539-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist