Provider Demographics
NPI:1497071807
Name:FIELD, BENJAMIN (DPH)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:FIELD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1360
Mailing Address - Country:US
Mailing Address - Phone:920-748-9867
Mailing Address - Fax:
Practice Address - Street 1:135 W HURON ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1545
Practice Address - Country:US
Practice Address - Phone:920-361-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14226-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist