Provider Demographics
NPI:1487087722
Name:TOLIVER, CORNELIUS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:
Last Name:TOLIVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 BRIGHTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-7977
Mailing Address - Country:US
Mailing Address - Phone:919-817-4540
Mailing Address - Fax:919-322-4728
Practice Address - Street 1:815 OBERLIN ROAD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605
Practice Address - Country:US
Practice Address - Phone:919-322-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC123456789Medicaid