Healthcare Provider Details

I. General information

NPI: 1982412490
Provider Name (Legal Business Name): DAULTON JOSHUA BUETNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E STATE ST
ALLIANCE OH
44601-4936
US

IV. Provider business mailing address

289 TANGLEWOOD DR SW
NORTH CANTON OH
44720-3513
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6000
  • Fax:
Mailing address:
  • Phone: 419-303-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03443341
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: