Healthcare Provider Details

I. General information

NPI: 1215871959
Provider Name (Legal Business Name): ZACHARY PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S 500 E
SALT LAKE CITY UT
84102-2753
US

IV. Provider business mailing address

7434 W DESERT BRUMBY DR
HERRIMAN UT
84096-5421
US

V. Phone/Fax

Practice location:
  • Phone: 801-915-3027
  • Fax:
Mailing address:
  • Phone: 801-915-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9681516-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: