Provider Demographics
NPI:1023417128
Name:LYLES, DIANE
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:LYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:LYLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:FLORENCE MEDICAL PAVILION B 805 PAMPLICO HWY
Mailing Address - Street 2:STE 130
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505
Mailing Address - Country:US
Mailing Address - Phone:803-674-2950
Mailing Address - Fax:
Practice Address - Street 1:FLORENCE MEDICAL PAVILION B 805 PAMPLICO HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505
Practice Address - Country:US
Practice Address - Phone:843-674-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist