=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912405390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSH L FIELDS PHARMD.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2018
-----------------------------------------------------
Last Update Date | 01/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 PALM BAY RD NE
-----------------------------------------------------
City | WEST MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32904-8601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-722-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2579 LEMON ST NE
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-205-5916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS42435
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------