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NPI Code Detail

MEDICARE: MS. IANTHA MARIE PAYNE

MEDICARE: MS. IANTHA MARIE PAYNE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist27232TX

General Provider Information

NPI Number : 1215249792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IANTHA MARIE PAYNE
Provider Business Mailing Address
First Line : 5300 N BRAESWOOD BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77096-3307
Country : US
Telephone Number : 713-721-1516
Fax Number :
Provider Business Practice Location Address
First Line : 5300 N BRAESWOOD BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77096-3307
Country : US
Telephone Number : 713-721-1516
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2010
Last Update Date : 07/13/2010

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Directions to “ MS. IANTHA MARIE PAYNE ” Practice Location

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