Provider Demographics
NPI:1376829366
Name:FIELDS, RENEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3462
Mailing Address - Country:US
Mailing Address - Phone:920-921-5264
Mailing Address - Fax:920-921-2760
Practice Address - Street 1:192 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3462
Practice Address - Country:US
Practice Address - Phone:920-921-5264
Practice Address - Fax:920-921-2760
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15454-40183500000X
IA19748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist