Provider Demographics
NPI:1396347944
Name:NEELY, LAURA ANN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:NEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-7509
Mailing Address - Country:US
Mailing Address - Phone:717-460-1550
Mailing Address - Fax:
Practice Address - Street 1:700 SUNHAVEN CIR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-7509
Practice Address - Country:US
Practice Address - Phone:717-460-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038531L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist