Provider Demographics
NPI:1497880728
Name:FIELDS, GARY VINCENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:VINCENT
Last Name:FIELDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLUB AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2001
Mailing Address - Country:US
Mailing Address - Phone:610-868-5857
Mailing Address - Fax:610-746-6583
Practice Address - Street 1:102 EASTON RD
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-3011
Practice Address - Country:US
Practice Address - Phone:610-759-6066
Practice Address - Fax:610-746-6583
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028956L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist