Provider Demographics
NPI:1982586574
Name:KINSLOW, DALTON LEE
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:LEE
Last Name:KINSLOW
Suffix:
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 1:850 WASHBURN AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6786
Mailing Address - Country:US
Mailing Address - Phone:270-646-6968
Mailing Address - Fax:
Practice Address - Street 1:5360 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1564
Practice Address - Country:US
Practice Address - Phone:502-447-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY025204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist