Provider Demographics
NPI:1730413659
Name:FIELDS, WILLIAM RUSSELL (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:FIELDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ALBERT CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2209
Mailing Address - Country:US
Mailing Address - Phone:317-846-2845
Mailing Address - Fax:
Practice Address - Street 1:801 CONGRESSIONAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5646
Practice Address - Country:US
Practice Address - Phone:317-818-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012371A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist