Healthcare Provider Details

I. General information

NPI: 1376634329
Provider Name (Legal Business Name): FIELDS FAMILY ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 SOUTH MAIN STREET
WAYNESVILLE OH
45068
US

IV. Provider business mailing address

415 SOUTH MAIN STREET
WAYNESVILLE OH
45068
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02-565750
License Number StateOH

VIII. Authorized Official

Name: MR. KENNETH J FIELDS
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 513-897-7076