Healthcare Provider Details

I. General information

NPI: 1366596603
Provider Name (Legal Business Name): JEFF ALBERT DALTON RPH, PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 BIG A RD INGLES PHARMACY
TOCCOA GA
30577-6028
US

IV. Provider business mailing address

1197 BIG A RD INGLES PHARMACY
TOCCOA GA
30577-6028
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-8711
  • Fax: 706-886-4956
Mailing address:
  • Phone: 706-886-8711
  • Fax: 706-886-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH021281
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRPH021281
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerGEROGIA PHARMACIST LICENS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: