Provider Demographics
NPI:1437431194
Name:NEAL, WITHANIA THERESA (PHARM D)
Entity type:Individual
Prefix:MISS
First Name:WITHANIA
Middle Name:THERESA
Last Name:NEAL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4638
Mailing Address - Country:US
Mailing Address - Phone:225-292-8975
Mailing Address - Fax:225-292-4746
Practice Address - Street 1:4747 S SHERWOOD FOREST BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4638
Practice Address - Country:US
Practice Address - Phone:225-292-8975
Practice Address - Fax:225-292-4746
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist