Provider Demographics
NPI:1588418149
Name:FISHER, LUCAS (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-2544
Mailing Address - Country:US
Mailing Address - Phone:407-327-9362
Mailing Address - Fax:
Practice Address - Street 1:401 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-2544
Practice Address - Country:US
Practice Address - Phone:407-327-9362
Practice Address - Fax:407-327-6853
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist