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General NPI Number Information
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NPI Number | 1245342187
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Entity Type | Organization
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Legal Business Name | PAYNES PRESCRIPTION PHARMACY INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 53 S CENTER ST
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City | FLORA
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State | IN
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Zip | 46929-1315
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Country | US
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Telephone | 574-967-3762
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Fax | 574-967-4389
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Provider Business Mailing Address
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Address Line | 53 S CENTER ST
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City | FLORA
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State | IN
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Zip | 46929-1315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JIM PAYNE
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Credential |
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Telephone | 574-967-3762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60001659A
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License Number State | IN
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