Provider Demographics
NPI:1790771558
Name:DUNGAN, NEAL CLIFFORD
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:CLIFFORD
Last Name:DUNGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ALPHA ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4605
Mailing Address - Country:US
Mailing Address - Phone:505-885-1560
Mailing Address - Fax:
Practice Address - Street 1:2402 W PIERCE ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3537
Practice Address - Country:US
Practice Address - Phone:505-885-2979
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist