Healthcare Provider Details

I. General information

NPI: 1710583257
Provider Name (Legal Business Name): ANTHONY FIELDS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N 6TH ST STE 201
MILWAUKEE WI
53212-4006
US

IV. Provider business mailing address

1311 N 6TH ST STE 201
MILWAUKEE WI
53212-4006
US

V. Phone/Fax

Practice location:
  • Phone: 414-223-6874
  • Fax: 414-223-6821
Mailing address:
  • Phone: 414-223-6874
  • Fax: 833-368-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14021-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: