Provider Demographics
NPI:1801178512
Name:NEAL, EDWARD COCHRAN (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:COCHRAN
Last Name:NEAL
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 1:500 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4422
Mailing Address - Country:US
Mailing Address - Phone:217-234-4213
Mailing Address - Fax:
Practice Address - Street 1:212 S LOGAN AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4595
Practice Address - Country:US
Practice Address - Phone:217-235-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051029224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL40022346057OtherDRIVERS LICENSE