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General NPI Number Information
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NPI Number | 1760896153
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Entity Type | Individual
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Provider Name | ROBERT TERRY DALTON JR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 603 S HIGHWAY 365
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City | BURNSVILLE
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State | MS
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Zip | 38833-9706
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Country | US
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Telephone | 662-427-0200
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Fax | 662-427-0101
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Provider Business Mailing Address
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Address Line | 603 S HIGHWAY 365
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City | BURNSVILLE
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State | MS
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Zip | 38833-9706
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Country | US
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Telephone | 662-427-0200
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Fax | 662-427-0101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-07806
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License Number State | MS
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