Provider Demographics
NPI:1225500036
Name:OXENDINE-DIAL, DONNA JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:OXENDINE-DIAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E WARDELL DR STE PHARMACY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7998
Mailing Address - Country:US
Mailing Address - Phone:910-668-1172
Mailing Address - Fax:910-521-2878
Practice Address - Street 1:307 E WARDELL DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372
Practice Address - Country:US
Practice Address - Phone:910-668-1172
Practice Address - Fax:910-521-2878
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist