Basic Information
| Provider Information | |||||||||
| NPI: | 1194828590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAYTON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14900 | ||||||||
| Address2: | STATE OF OREGON OREGON STATE HOSPITAL IRS UNIT | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973095016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039452800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2600 CENTER ST NE | ||||||||
| Address2: | OREGON STATE HOSPITAL | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039452800 | ||||||||
| FaxNumber: | 5039471085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6371 | OR | X | Pharmacy Service Providers | Pharmacist | 1835P1300X | 6371 | OR | X | Pharmacy Service Providers | Pharmacist | Psychiatric |
No ID Information.