Provider Demographics
NPI:1497858682
Name:FISHER, WILLIAM EUGENE
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 DRURY CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1084
Mailing Address - Country:US
Mailing Address - Phone:904-826-3449
Mailing Address - Fax:
Practice Address - Street 1:5050 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3601
Practice Address - Country:US
Practice Address - Phone:904-370-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist