Healthcare Provider Details

I. General information

NPI: 1780725895
Provider Name (Legal Business Name): WILLIAM MCMICHAEL PAYNE II PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 LAKEVIEW
STANSBURY PARK UT
84074-9608
US

IV. Provider business mailing address

71 LAKEVIEW
STANSBURY PARK UT
84074-9608
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-7933
  • Fax:
Mailing address:
  • Phone: 435-882-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5297852-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: