MEDICARE: DANIELLE GLORIA PAYNE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12977	SC
2	183500000X	Pharmacist	21246	NC

General Provider Information

NPI Number	:	1871806778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE GLORIA PAYNE PHARMD

Provider Business Mailing Address
First Line	:	1735 HECKLE BLVD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-4803
Country	:	US
Telephone Number	:	803-372-6369
Fax Number	:	803-372-6377

Provider Business Practice Location Address
First Line	:	1735 HECKLE BLVD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-4803
Country	:	US
Telephone Number	:	803-372-6369
Fax Number	:	803-372-6377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	06/12/2015

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