Provider Demographics
NPI:1467780064
Name:NEIL, LAURA RAE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:RAE
Last Name:NEIL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 DROMIN LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6018
Mailing Address - Country:US
Mailing Address - Phone:478-397-8936
Mailing Address - Fax:
Practice Address - Street 1:1164 DROMIN LN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6018
Practice Address - Country:US
Practice Address - Phone:478-397-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
070108253672868183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician