Provider Demographics
NPI:1942895636
Name:BARTON, DONALD DALE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:DALE
Last Name:BARTON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8603
Mailing Address - Country:US
Mailing Address - Phone:903-360-2698
Mailing Address - Fax:
Practice Address - Street 1:1620 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4260
Practice Address - Country:US
Practice Address - Phone:903-360-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist