Provider Demographics
NPI:1679868152
Name:DALTON, DIANA ALEXIS (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ALEXIS
Last Name:DALTON
Suffix:
Gender:F
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 7
Mailing Address - Street 2:347 NORFOLK RD
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-0007
Mailing Address - Country:US
Mailing Address - Phone:860-567-4075
Mailing Address - Fax:
Practice Address - Street 1:331 WEST ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3406
Practice Address - Country:US
Practice Address - Phone:860-567-7064
Practice Address - Fax:860-567-7062
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist