Provider Demographics
NPI:1154542124
Name:DAYVAULT, ROBERT LEE JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:DAYVAULT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 CROFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081
Mailing Address - Country:US
Mailing Address - Phone:704-938-1931
Mailing Address - Fax:
Practice Address - Street 1:1113 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081
Practice Address - Country:US
Practice Address - Phone:704-932-9111
Practice Address - Fax:704-932-2270
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist