Provider Demographics
NPI:1982981569
Name:FAIRFIELD, MARK KEVIN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEVIN
Last Name:FAIRFIELD
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 1:1608 HYLAND ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:95524-9302
Mailing Address - Country:US
Mailing Address - Phone:707-826-7981
Mailing Address - Fax:
Practice Address - Street 1:2525 4TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0823
Practice Address - Country:US
Practice Address - Phone:707-442-0549
Practice Address - Fax:707-442-0549
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist