=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497007728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JAMES DALLAS NEAL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2012
-----------------------------------------------------
Last Update Date | 10/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1122 RANDOLPH ST
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27360-5175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-476-8190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1122 RANDOLPH ST
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27360-5175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-476-8190
-----------------------------------------------------
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 | 6876
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------