Provider Demographics
NPI:1023331485
Name:NEALIS, WILLIAM SHAWN (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SHAWN
Last Name:NEALIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 KATONAH AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-2015
Mailing Address - Country:US
Mailing Address - Phone:718-944-0862
Mailing Address - Fax:718-944-0864
Practice Address - Street 1:4295 KATONAH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-2015
Practice Address - Country:US
Practice Address - Phone:718-944-0862
Practice Address - Fax:718-944-0864
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist