Provider Demographics
NPI:1568249415
Name:NEAL, SHANNON DELAINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DELAINA
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 1:2412 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2417
Mailing Address - Country:US
Mailing Address - Phone:573-225-2729
Mailing Address - Fax:
Practice Address - Street 1:1723 BROADWAY ST STE 110
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-331-7900
Practice Address - Fax:573-331-7909
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296980183500000X
TN42048183500000X
MO2013026468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist