Provider Demographics
NPI:1477555373
Name:FIELDS FAMILY ENTERPRISE, INC
Entity Type:Organization
Organization Name:FIELDS FAMILY ENTERPRISE, INC
Other - Org Name:WAYNESVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:513-897-7076
Mailing Address - Street 1:415 S MAIN ST
Mailing Address - Street 2:P.O. BOX 636
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-9553
Mailing Address - Country:US
Mailing Address - Phone:513-897-7076
Mailing Address - Fax:513-897-1446
Practice Address - Street 1:415 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9553
Practice Address - Country:US
Practice Address - Phone:513-897-7076
Practice Address - Fax:513-897-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-565750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721268Medicaid
OH0721268Medicaid