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General NPI Number Information
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NPI Number | 1740720176
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Entity Type | Individual
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Provider Name | DIONNE LAND-PROPHET RPH
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Gender | Female
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Dates
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Enumeration Date | 03/05/2017
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 115 STONE VILLAGE DR
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City | FORT MILL
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State | SC
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Zip | 29708-6489
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Country | US
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Telephone | 803-239-4562
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Fax |
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Provider Business Mailing Address
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Address Line | 4715 LAPIS CT
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City | FORT MILL
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State | SC
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Zip | 29708-8373
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Country | US
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Telephone | 803-239-4562
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14010
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License Number State | SC
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