Provider Demographics
NPI:1316036262
Name:SHORT-GRAYBILL, DAYNA P (RPH)
Entity type:Individual
Prefix:MRS
First Name:DAYNA
Middle Name:P
Last Name:SHORT-GRAYBILL
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 1:4435 HAZLETON
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8270
Mailing Address - Country:US
Mailing Address - Phone:407-295-8125
Mailing Address - Fax:
Practice Address - Street 1:5739 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5258
Practice Address - Country:US
Practice Address - Phone:407-293-6600
Practice Address - Fax:407-293-0222
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBW4910750OtherDEA NUMBER