Provider Demographics
NPI:1114369303
Name:DV PROPERTIES INC
Entity Type:Organization
Organization Name:DV PROPERTIES INC
Other - Org Name:DALTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,VP
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-978-5102
Mailing Address - Street 1:1640 S WILSON DAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2768
Mailing Address - Country:US
Mailing Address - Phone:256-978-5102
Mailing Address - Fax:256-978-5108
Practice Address - Street 1:1110 E 6TH ST STE A
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3957
Practice Address - Country:US
Practice Address - Phone:256-978-5102
Practice Address - Fax:256-978-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0004X
AL1141863336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL171734Medicaid
2151770OtherPK