Provider Demographics
NPI:1215548250
Name:FIELDS, LEO WALTER JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:WALTER
Last Name:FIELDS
Suffix:JR
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 1:1699 CHATHAM PKWY APT 1327A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-7618
Mailing Address - Country:US
Mailing Address - Phone:904-403-1461
Mailing Address - Fax:
Practice Address - Street 1:101 BLUE MOON XING
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9797
Practice Address - Country:US
Practice Address - Phone:912-348-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist