Provider Demographics
NPI:1609174846
Name:DIAL, ALISIA EMILY
Entity Type:Individual
Prefix:MRS
First Name:ALISIA
Middle Name:EMILY
Last Name:DIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MAR MAC RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29626-5267
Mailing Address - Country:US
Mailing Address - Phone:864-231-9319
Mailing Address - Fax:864-964-9637
Practice Address - Street 1:107 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5514
Practice Address - Country:US
Practice Address - Phone:864-964-1606
Practice Address - Fax:864-964-9637
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2011-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist