Provider Demographics
NPI:1437119419
Name:FIELDS, MICHELLE R (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:R
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 NW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1539
Mailing Address - Country:US
Mailing Address - Phone:352-367-1981
Mailing Address - Fax:
Practice Address - Street 1:1 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611
Practice Address - Country:US
Practice Address - Phone:352-392-1760
Practice Address - Fax:352-846-1521
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician