Provider Demographics
NPI:1265032254
Name:HANSEL, NEAL ALAN
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:ALAN
Last Name:HANSEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 S HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3197
Mailing Address - Country:US
Mailing Address - Phone:417-619-8632
Mailing Address - Fax:
Practice Address - Street 1:1401 OLD EXETER RD
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-9415
Practice Address - Country:US
Practice Address - Phone:417-847-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18891183500000X
ARPD13366183500000X
MO2005021291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist