Provider Demographics
NPI:1417232463
Name:CORONADO, NEIL P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:P
Last Name:CORONADO
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 1:3130 W CAREFREE HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3200
Mailing Address - Country:US
Mailing Address - Phone:623-582-2743
Mailing Address - Fax:623-582-8074
Practice Address - Street 1:3130 W CAREFREE HWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-3200
Practice Address - Country:US
Practice Address - Phone:623-582-2743
Practice Address - Fax:623-582-8074
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist