Provider Demographics
NPI:1316356389
Name:MCNEILL, PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MCNEILL
Suffix:
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 1:4685 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2618
Mailing Address - Country:US
Mailing Address - Phone:520-326-4341
Mailing Address - Fax:
Practice Address - Street 1:4685 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2618
Practice Address - Country:US
Practice Address - Phone:520-326-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS020743OtherARIZONA STATE BOARD OF PHARMACY PHARMACIST LICENSE