MEDICARE: FIELDS FAMILY ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	021741050	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3676458	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1013106202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIELDS FAMILY ENTERPRISES INC

Provider Business Mailing Address
First Line	:	415 S MAIN ST
Second Line	:
City	:	WAYNESVILLE
State	:	OH
Zip	:	45068-9553
Country	:	US
Telephone Number	:	513-897-7076
Fax Number	:	513-897-1446

Provider Business Practice Location Address
First Line	:	101 E ALEX BELL RD STE 172
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2752
Country	:	US
Telephone Number	:	937-221-9240
Fax Number	:	937-795-3291

Authorized Official
Title or Position	:	PIC, DIRECTOR OF PHARMACY
Name	:	DR. JORDAN MARK MULLINS
Credential	:	PHARMD
Telephone Number	:	513-600-8236

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	05/08/2024

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Directions to “FIELDS FAMILY ENTERPRISES INC ” Practice Location

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