Provider Demographics
NPI:1609464296
Name:DALTON, JEFFERY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-0038
Mailing Address - Country:US
Mailing Address - Phone:434-369-5257
Mailing Address - Fax:434-369-1061
Practice Address - Street 1:1230 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1466
Practice Address - Country:US
Practice Address - Phone:434-369-5257
Practice Address - Fax:434-369-1061
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist