Provider Demographics
NPI:1083103469
Name:FIELDS, SUSAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N 7 HWY
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-1938
Mailing Address - Country:US
Mailing Address - Phone:816-427-9023
Mailing Address - Fax:
Practice Address - Street 1:1700 N 7 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-1938
Practice Address - Country:US
Practice Address - Phone:816-427-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16991183500000X
MO2015029215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist