Basic Information
| Provider Information | |||||||||
| NPI: | 1508858960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4299 S OLD MICHIGAN RD | ||||||||
| Address2: | |||||||||
| City: | HOLTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470239158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126896742 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 806 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127993287 | ||||||||
| FaxNumber: | 8127483413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 26017652 | IN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.