Provider Demographics
NPI:1275736381
Name:DALSING, ALAN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:M
Last Name:DALSING
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 1:207 N BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8461
Mailing Address - Country:US
Mailing Address - Phone:417-725-5867
Mailing Address - Fax:417-725-4007
Practice Address - Street 1:400 N MASSEY BLVD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8303
Practice Address - Country:US
Practice Address - Phone:417-725-6606
Practice Address - Fax:417-725-4007
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist