Provider Demographics
NPI:1316343569
Name:FISHER, EVELYN O
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:O
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 TEXAS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3121
Mailing Address - Country:US
Mailing Address - Phone:832-230-0169
Mailing Address - Fax:832-230-0252
Practice Address - Street 1:1965 TEXAS PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3121
Practice Address - Country:US
Practice Address - Phone:832-230-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist