Provider Demographics
NPI:1669094629
Name:NEAL, LEE GARY (RPH)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:GARY
Last Name:NEAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2215 E VILLA MARIA RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2585
Mailing Address - Country:US
Mailing Address - Phone:979-977-0193
Mailing Address - Fax:979-776-0427
Practice Address - Street 1:2215 E VILLA MARIA RD STE 120
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2585
Practice Address - Country:US
Practice Address - Phone:979-977-0193
Practice Address - Fax:979-776-0427
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564711835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology