MEDICARE: LISA ANN PAYNE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13210	AL

General Provider Information

NPI Number	:	1790022713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN PAYNE RPH

Provider Business Mailing Address
First Line	:	4730 HIGHWAY 17
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-3503
Country	:	US
Telephone Number	:	205-620-0292
Fax Number	:	205-620-0336

Provider Business Practice Location Address
First Line	:	4730 HIGHWAY 17
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-3503
Country	:	US
Telephone Number	:	205-620-0292
Fax Number	:	205-620-0336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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