Provider Demographics
NPI:1962794065
Name:ADDESSO, NEIL MICHAEL JR (PHARMD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:MICHAEL
Last Name:ADDESSO
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7386 HARBOUR TOWNE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3463
Mailing Address - Country:US
Mailing Address - Phone:757-483-4129
Mailing Address - Fax:757-483-4240
Practice Address - Street 1:7386 HARBOUR TOWNE PKWY STE A
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3463
Practice Address - Country:US
Practice Address - Phone:757-483-4129
Practice Address - Fax:757-483-4240
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist