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1891076154 NPI number — NATHAN PAYNE PHARMD

NPI Number: 1891076154
Health Care Provider/Practitioner: NATHAN PAYNE PHARMD

Information about “1891076154” NPI (NATHAN PAYNE PHARMD) exists in 1891076154 in HTML format HTML  |  1891076154 in plain Text format TXT  |  1891076154 in PDF (Portable Document Format) PDF  |  1891076154 in an XML format XML  formats.

NPI Number : 1891076154 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891076154",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PAYNE",
    "FirstName": "NATHAN",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3220 HALIFAX RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH BOSTON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24592-4908",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "434-575-5338",
    "MailingAddressFaxNumber": "434-575-5976",
    "FirstLinePracticeLocationAddress": "318 CRAGHEAD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DANVILLE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24541-1416",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "434-425-0701",
    "PracticeLocationAddressFaxNumber": "434-575-5976",
    "EnumerationDate": "08/31/2011",
    "LastUpdateDate": "06/04/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "19822",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "0202208484",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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