Provider Demographics
NPI:1417619677
Name:NEALE, THOMAS MANNING JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MANNING
Last Name:NEALE
Suffix:JR
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 1:3020 CORPORATE CT STE 300
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5617
Mailing Address - Country:US
Mailing Address - Phone:972-539-3624
Mailing Address - Fax:972-539-3694
Practice Address - Street 1:721 E SOUTHLAKE BLVD STE 180
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6587
Practice Address - Country:US
Practice Address - Phone:817-410-1000
Practice Address - Fax:817-410-1001
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29336OtherPHARMACIST LICENSE NUMBER