Provider Demographics
NPI:1023539228
Name:PAYNE, MONICA D (PHARMD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:D
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:SECTION
Mailing Address - State:AL
Mailing Address - Zip Code:35771-0108
Mailing Address - Country:US
Mailing Address - Phone:256-228-7179
Mailing Address - Fax:
Practice Address - Street 1:5295 TAMMY LITTLE DRIVE
Practice Address - Street 2:
Practice Address - City:SECTION
Practice Address - State:AL
Practice Address - Zip Code:35771-7206
Practice Address - Country:US
Practice Address - Phone:256-228-7179
Practice Address - Fax:256-228-4614
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18849OtherPHARMACIST LICENSE