Provider Demographics
NPI:1689204802
Name:NEAL, KAYLA DANIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DANIELLE
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 1:50827 HIGHWAY 550 APT 356
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-9602
Mailing Address - Country:US
Mailing Address - Phone:785-844-1828
Mailing Address - Fax:
Practice Address - Street 1:28 TOWN PLZ
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5102
Practice Address - Country:US
Practice Address - Phone:970-247-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist