Provider Demographics
NPI:1922301803
Name:DALTON, DAVID L (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
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 1:38 STAGS LEAP CT
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1029
Mailing Address - Country:US
Mailing Address - Phone:443-253-0194
Mailing Address - Fax:
Practice Address - Street 1:38 STAGS LEAP CT
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1029
Practice Address - Country:US
Practice Address - Phone:443-253-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist