Individual
MR. KENNETH DALTON BLIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHT, PRS
Contact information
Practice address
3303 SW BOND AVE STE 11501, PORTLAND, OR 97239-4501
(503) 418-9894
(503) 418-9897
Mailing address
3303 SW BOND AVE STE 11501, PORTLAND, OR 97239-4501
(503) 418-9894
(503) 418-9897
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CPT-0010020
OR
183700000X
Pharmacy Technician
RPT47760
FL
Other
Enumeration date
11/03/2016
Last updated
11/03/2016
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