Provider Demographics
NPI:1467885236
Name:HUGHES, DALTON JOSEPH
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:JOSEPH
Last Name:HUGHES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 ALTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8203
Mailing Address - Country:US
Mailing Address - Phone:949-250-4465
Mailing Address - Fax:949-250-7415
Practice Address - Street 1:3875 ALTON PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8203
Practice Address - Country:US
Practice Address - Phone:949-250-4465
Practice Address - Fax:949-250-7415
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH32259183500000X
CA32259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicaid