=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124995683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAYTEN WENDT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2508 S DAY ST
-----------------------------------------------------
City | BRENHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77833-5521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-277-0906
-----------------------------------------------------
Fax | 866-528-9552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2508 S DAY ST
-----------------------------------------------------
City | BRENHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77833-5521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-277-0906
-----------------------------------------------------
Fax | 866-528-9552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 328881
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------