Healthcare Provider Details

I. General information

NPI: 1457073744
Provider Name (Legal Business Name): DALTON CRANE VINING PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 SHALLOWFORD RD NE APT F
CHAMBLEE GA
30341-5253
US

IV. Provider business mailing address

2765 SHALLOWFORD RD NE APT F
CHAMBLEE GA
30341-5253
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH033817
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: