Healthcare Provider Details

I. General information

NPI: 1629541339
Provider Name (Legal Business Name): ERIC L NEAL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 KENSHALO ST
ALBANY TX
76430-3218
US

IV. Provider business mailing address

450 KENSHALO ST
ALBANY TX
76430-3218
US

V. Phone/Fax

Practice location:
  • Phone: 325-762-3979
  • Fax:
Mailing address:
  • Phone: 325-762-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number29931
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: