Provider Demographics
NPI:1316214034
Name:FIELDS, MESHA (RPH)
Entity Type:Individual
Prefix:
First Name:MESHA
Middle Name:
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 1:1311 N STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3701
Mailing Address - Country:US
Mailing Address - Phone:217-429-1988
Mailing Address - Fax:217-429-9577
Practice Address - Street 1:1311 N STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3701
Practice Address - Country:US
Practice Address - Phone:217-429-1988
Practice Address - Fax:217-429-9577
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist