=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114143732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACIE ALEXANDRA NEAL PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2708 BRIDGE AVE
-----------------------------------------------------
City | ALBERT LEA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56007-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-373-1899
-----------------------------------------------------
Fax | 507-373-2179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1117 FOOTHILLS CIR
-----------------------------------------------------
City | ALBERT LEA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56007-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-377-2641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 118220
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------