Provider Demographics
NPI:1255678637
Name:MAYNOR, HEATHER LYNETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNETTE
Last Name:MAYNOR
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 1:444 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-8820
Mailing Address - Country:US
Mailing Address - Phone:910-718-5200
Mailing Address - Fax:910-718-5080
Practice Address - Street 1:444 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:FAISON
Practice Address - State:NC
Practice Address - Zip Code:28341-8820
Practice Address - Country:US
Practice Address - Phone:910-718-5200
Practice Address - Fax:910-718-5080
Is Sole Proprietor?:No
Enumeration Date:2013-01-06
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22980OtherNCBOP LICENSE