Provider Demographics
NPI:1891371803
Name:STEWART, DALTON BRYAN
Entity Type:Individual
Prefix:MR
First Name:DALTON
Middle Name:BRYAN
Last Name:STEWART
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 1:1095 INDUSTRIAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36571
Mailing Address - Country:US
Mailing Address - Phone:251-675-8073
Mailing Address - Fax:
Practice Address - Street 1:1095 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3719
Practice Address - Country:US
Practice Address - Phone:251-675-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT50753183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician