Healthcare Provider Details

I. General information

NPI: 1821953027
Provider Name (Legal Business Name): SHANNON MARY NEILEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 FALLS OF NEUSE RD STE 300
RALEIGH NC
27609-5480
US

IV. Provider business mailing address

5000 FALLS OF NEUSE RD STE 300
RALEIGH NC
27609-5480
US

V. Phone/Fax

Practice location:
  • Phone: 984-200-1549
  • Fax: 984-200-2542
Mailing address:
  • Phone: 984-200-1549
  • Fax: 984-200-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14543
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: