Provider Demographics
NPI:1164681805
Name:WILLSEY, NEIL ANDREW (RPH)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:ANDREW
Last Name:WILLSEY
Suffix:
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 1:7519 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1726
Mailing Address - Country:US
Mailing Address - Phone:502-231-2424
Mailing Address - Fax:502-231-8748
Practice Address - Street 1:7519 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1726
Practice Address - Country:US
Practice Address - Phone:502-231-2424
Practice Address - Fax:502-231-8748
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist