Provider Demographics
NPI:1871806778
Name:PAYNE, DANIELLE GLORIA (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:GLORIA
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 HECKLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4803
Mailing Address - Country:US
Mailing Address - Phone:803-372-6369
Mailing Address - Fax:803-372-6377
Practice Address - Street 1:1735 HECKLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4803
Practice Address - Country:US
Practice Address - Phone:803-372-6369
Practice Address - Fax:803-372-6377
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12977183500000X
NC21246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist