Provider Demographics
NPI:1629359567
Name:NEAL, LAUREL LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:LYNN
Last Name:NEAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 SAVONNE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4977
Mailing Address - Country:US
Mailing Address - Phone:636-536-9789
Mailing Address - Fax:
Practice Address - Street 1:15253 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4604
Practice Address - Country:US
Practice Address - Phone:636-227-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003023847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist