Provider Demographics
NPI:1609471622
Name:FISCHER, MICHELLE LYNN-PATZACK (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN-PATZACK
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W STATE HIGHWAY 152
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3902
Mailing Address - Country:US
Mailing Address - Phone:405-376-3340
Mailing Address - Fax:
Practice Address - Street 1:3900 S CEMETERY RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7214
Practice Address - Country:US
Practice Address - Phone:405-514-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist