Provider Demographics
NPI:1992796809
Name:FIELD PHARMACY INC
Entity type:Organization
Organization Name:FIELD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMAICST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-651-5461
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-0279
Mailing Address - Country:US
Mailing Address - Phone:517-651-5461
Mailing Address - Fax:517-651-5573
Practice Address - Street 1:7404 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-9759
Practice Address - Country:US
Practice Address - Phone:517-651-5461
Practice Address - Fax:517-651-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010010333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2300185Medicaid
2300185OtherNCPDP PROVIDER IDENTIFICATION NUMBER