Provider Demographics
NPI:1821482555
Name:FIELDS, BRYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PHARMD
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 2719
Mailing Address - Street 2:FOOD CITY PHARMACY
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-2719
Mailing Address - Country:US
Mailing Address - Phone:606-237-1175
Mailing Address - Fax:606-237-7491
Practice Address - Street 1:28093 THOMPSON PLAZA
Practice Address - Street 2:FOOD CITY PHARMACY
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-2719
Practice Address - Country:US
Practice Address - Phone:606-237-1175
Practice Address - Fax:606-237-7491
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014128183500000X
WVRP0007229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist