Provider Demographics
NPI:1356444582
Name:DIAL, CORNELIUS (RPH)
Entity Type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:
Last Name:DIAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:NEILL
Other - Middle Name:
Other - Last Name:DIAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1414 NW NORTHRUP ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2790
Mailing Address - Country:US
Mailing Address - Phone:503-414-5595
Mailing Address - Fax:503-414-7795
Practice Address - Street 1:1414 NW NORTHRUP ST
Practice Address - Street 2:SUITE 800
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2790
Practice Address - Country:US
Practice Address - Phone:503-414-5595
Practice Address - Fax:503-414-7795
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist