Provider Demographics
NPI:1417191461
Name:FIELDS, DOMINIQUE MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:MARIE
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 1:65 WEST JIMMIE LEEDS ROAD
Mailing Address - Street 2:ATLANTICARE REGIONAL MEDICAL CENTER
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08240
Mailing Address - Country:US
Mailing Address - Phone:609-748-4018
Mailing Address - Fax:609-404-3889
Practice Address - Street 1:65 W. JIMMIE LEEDS ROAD
Practice Address - Street 2:ATLANTICARE REGIONAL MEDICAL CENTER
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08240
Practice Address - Country:US
Practice Address - Phone:609-748-4018
Practice Address - Fax:609-404-3889
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02424600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist