Provider Demographics
NPI:1710059621
Name:DALTON-JOHNSON, NANCY LEIGH (RPH)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEIGH
Last Name:DALTON-JOHNSON
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 305
Mailing Address - Street 2:
Mailing Address - City:ARLEE
Mailing Address - State:MT
Mailing Address - Zip Code:59821-0305
Mailing Address - Country:US
Mailing Address - Phone:406-726-4134
Mailing Address - Fax:
Practice Address - Street 1:110 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ST IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865
Practice Address - Country:US
Practice Address - Phone:406-745-3000
Practice Address - Fax:406-745-3003
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3885OtherLICENSE