Healthcare Provider Details

I. General information

NPI: 1982918272
Provider Name (Legal Business Name): GREG DAYTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 GRAPEVINE HWY
HURST TX
76054-2758
US

IV. Provider business mailing address

3663 BRIARPARK DR
HOUSTON TX
77042-5205
US

V. Phone/Fax

Practice location:
  • Phone: 817-281-0456
  • Fax: 817-281-0489
Mailing address:
  • Phone: 713-268-3630
  • Fax: 623-869-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22685
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: