Provider Demographics
NPI:1194872887
Name:FISHER, CARLA R (RPH)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:R
Last Name:FISHER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-5812
Mailing Address - Country:US
Mailing Address - Phone:605-882-0045
Mailing Address - Fax:605-886-0721
Practice Address - Street 1:1320 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-5302
Practice Address - Country:US
Practice Address - Phone:605-886-0661
Practice Address - Fax:605-886-0721
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist