Provider Demographics
NPI:1497319206
Name:NEAL, NICOLE MCHARGUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MCHARGUE
Last Name:NEAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:MO
Mailing Address - Zip Code:64640-1434
Mailing Address - Country:US
Mailing Address - Phone:660-663-7979
Mailing Address - Fax:
Practice Address - Street 1:403 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-1434
Practice Address - Country:US
Practice Address - Phone:660-663-7979
Practice Address - Fax:660-663-2963
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190135493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO045026OtherMISSOURI STATE BOARD OF PHARMACY PHARMACIST LICENSE
MO2500053920OtherBNDD LICENSE
MO2019013549OtherMISSOURI STATE BOARD OF PHARMACY PERMIT