Provider Demographics
NPI:1114209814
Name:NEELY, SUSAN ELAINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
Last Name:NEELY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-3563
Mailing Address - Country:US
Mailing Address - Phone:941-755-8596
Mailing Address - Fax:
Practice Address - Street 1:4320 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-3563
Practice Address - Country:US
Practice Address - Phone:941-755-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist