Provider Demographics
NPI:1679847966
Name:NEELEY, BRENT DELBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DELBERT
Last Name:NEELEY
Suffix:
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 1:929 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6508
Mailing Address - Country:US
Mailing Address - Phone:541-957-3058
Mailing Address - Fax:541-673-8213
Practice Address - Street 1:929 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6508
Practice Address - Country:US
Practice Address - Phone:541-957-3058
Practice Address - Fax:541-673-8213
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0006544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist