Basic Information
| Provider Information | |||||||||
| NPI: | 1740937853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | GAGE | ||||||||
| MiddleName: | FREEDOM | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 37 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUCKHANNON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262012235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044735600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 37 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUCKHANNON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262012235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044735600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2022 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RP0012782 | WV | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.