Provider Demographics
NPI:1710284708
Name:VANDEVENDER, NEAL ASTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:ASTON
Last Name:VANDEVENDER
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 1:211 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1328
Mailing Address - Country:US
Mailing Address - Phone:770-253-8562
Mailing Address - Fax:770-304-3701
Practice Address - Street 1:211 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1328
Practice Address - Country:US
Practice Address - Phone:770-253-8562
Practice Address - Fax:770-304-3701
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist