Provider Demographics
NPI:1205025640
Name:DALTON, DANIEL WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WAYNE
Last Name:DALTON
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 1:10332 E PALOMINO RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-9102
Mailing Address - Country:US
Mailing Address - Phone:928-527-0802
Mailing Address - Fax:
Practice Address - Street 1:10332 E PALOMINO RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-9102
Practice Address - Country:US
Practice Address - Phone:928-527-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist