Provider Demographics
NPI:1730460775
Name:FIELD, TISHA RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TISHA
Middle Name:RENEE
Last Name:FIELD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5490 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-1908
Mailing Address - Country:US
Mailing Address - Phone:515-423-4363
Mailing Address - Fax:515-967-3893
Practice Address - Street 1:101 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1938
Practice Address - Country:US
Practice Address - Phone:515-967-2699
Practice Address - Fax:515-967-3893
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20176183500000X
IL051.290727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist