Provider Demographics
NPI:1720261787
Name:FISKE, NATHAN F (RPH)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:F
Last Name:FISKE
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12838-2301
Mailing Address - Country:US
Mailing Address - Phone:518-632-9293
Mailing Address - Fax:
Practice Address - Street 1:27-41 GANSEVOORT ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803
Practice Address - Country:US
Practice Address - Phone:518-798-2847
Practice Address - Fax:833-616-2562
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist