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NPI Code Detail

MEDICARE: JEYDA DELREESE GRUEL-FIELDS RPH

MEDICARE: JEYDA DELREESE GRUEL-FIELDS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26020088AIN

General Provider Information

NPI Number : 1326685108
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEYDA DELREESE GRUEL-FIELDS RPH
Provider Business Mailing Address
First Line : 5426 TOMAHAWK TRL
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4938
Country : US
Telephone Number : 260-602-4371
Fax Number :
Provider Business Practice Location Address
First Line : 7008 BLUFFTON RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-2706
Country : US
Telephone Number : 260-747-4136
Fax Number : 260-747-4137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2019
Last Update Date : 11/29/2019

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