Provider Demographics
NPI:1770594277
Name:FAIRFIELD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:FAIRFIELD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PHARMACY OPS
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-842-2611
Mailing Address - Street 1:303 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-1203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-1203
Practice Address - Country:US
Practice Address - Phone:618-842-2611
Practice Address - Fax:618-847-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336I0012XSuppliersPharmacyInstitutional Pharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1479915OtherOTHER ID NUMBER-COMMERCIAL NUMBER