Healthcare Provider Details

I. General information

NPI: 1578897419
Provider Name (Legal Business Name): KATHERINE VAUGHN FIELDS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
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
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 Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03227861-2
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: