Provider Demographics
NPI:1760712939
Name:FIELDS, BRIAN L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
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:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-0632
Mailing Address - Country:US
Mailing Address - Phone:276-935-7395
Mailing Address - Fax:
Practice Address - Street 1:1244 POE TOWN ST
Practice Address - Street 2:APT 5
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-6152
Practice Address - Country:US
Practice Address - Phone:276-935-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist