Provider Demographics
NPI:1093804270
Name:CARLSON, DALE ROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:ROY
Last Name:CARLSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2626
Mailing Address - Country:US
Mailing Address - Phone:307-532-3981
Mailing Address - Fax:
Practice Address - Street 1:901 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2626
Practice Address - Country:US
Practice Address - Phone:307-532-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19921835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy