Provider Demographics
NPI:1750934287
Name:DALTON HERZIG, INC.
Entity type:Organization
Organization Name:DALTON HERZIG, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-3499
Mailing Address - Street 1:904 AUTUMN RD STE 275
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3745
Mailing Address - Country:US
Mailing Address - Phone:501-224-3499
Mailing Address - Fax:
Practice Address - Street 1:904 AUTUMN RD STE 275
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3745
Practice Address - Country:US
Practice Address - Phone:501-224-3499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy