Healthcare Provider Details

I. General information

NPI: 1477555373
Provider Name (Legal Business Name): FIELDS FAMILY ENTERPRISE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S MAIN ST
WAYNESVILLE OH
45068-9553
US

IV. Provider business mailing address

415 S MAIN ST P.O. BOX 636
WAYNESVILLE OH
45068-9553
US

V. Phone/Fax

Practice location:
  • Phone: 513-897-7076
  • Fax: 513-897-1446
Mailing address:
  • Phone: 513-897-7076
  • Fax: 513-897-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number02-565750
License Number StateOH

VIII. Authorized Official

Name: MRS. ELLEN LINDA FIELDS
Title or Position: VICE-PRESIDENT
Credential: PHARM.D..
Phone: 513-897-7076