Provider Demographics
NPI:1538471628
Name:DENNIS, DIANNE (RPH)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2502
Mailing Address - Country:US
Mailing Address - Phone:803-359-9146
Mailing Address - Fax:803-359-3348
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2502
Practice Address - Country:US
Practice Address - Phone:803-359-9146
Practice Address - Fax:803-359-3348
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist