Provider Demographics
NPI:1528279742
Name:NEEL, DOUGLAS CARLTON JR (RPH)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CARLTON
Last Name:NEEL
Suffix:JR
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:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:ALTHA
Mailing Address - State:FL
Mailing Address - Zip Code:32421-0358
Mailing Address - Country:US
Mailing Address - Phone:850-762-9623
Mailing Address - Fax:
Practice Address - Street 1:2255 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-2541
Practice Address - Country:US
Practice Address - Phone:850-526-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0018859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist