Provider Demographics
NPI:1043747371
Name:FIELDS, SUSAN ANN (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:FIELDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31550 CHIEFTAIN DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9087
Mailing Address - Country:US
Mailing Address - Phone:740-380-2041
Mailing Address - Fax:
Practice Address - Street 1:31550 CHIEFTAIN DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9087
Practice Address - Country:US
Practice Address - Phone:740-380-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-08-23
Deactivation Date:2020-11-24
Deactivation Code:
Reactivation Date:2022-08-23
Provider Licenses
StateLicense IDTaxonomies
OH03-2-18173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist