Provider Demographics
NPI:1417221664
Name:FIELDS, ANTHONY BLAKE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BLAKE
Last Name:FIELDS
Suffix:
Gender:M
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 1:5015 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-3003
Mailing Address - Country:US
Mailing Address - Phone:540-869-1660
Mailing Address - Fax:540-869-1463
Practice Address - Street 1:5015 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-3003
Practice Address - Country:US
Practice Address - Phone:540-869-1660
Practice Address - Fax:540-869-1463
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist