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Organization

FISHER PHARMACY, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHN MICHAEL ROEHM RPH (PRESIDENT)
(850) 892-5612
Entity
Organization

Contact information

Practice address
688 BALDWIN AVE, DEFUNIAK SPRINGS, FL 32435-2596
(850) 892-5612
(850) 892-5089
Mailing address
688 BALDWIN AVE, DEFUNIAK SPRINGS, FL 32435-2596
(850) 892-5612
(850) 892-5089

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
PH000185
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104725600
FL
01
104725601
MEDICAID-DME
FL
Enumeration date
02/07/2007
Last updated
02/06/2015
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