Provider Demographics
NPI:1073811337
Name:FIELDS, JONATHAN M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SUNSET LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3914
Mailing Address - Country:US
Mailing Address - Phone:540-829-8893
Mailing Address - Fax:540-829-4195
Practice Address - Street 1:545 SUNSET LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3914
Practice Address - Country:US
Practice Address - Phone:540-829-8893
Practice Address - Fax:540-829-4195
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist