Provider Demographics
NPI:1164708210
Name:PAYNE, CONSTANCE WHEATLEY (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:WHEATLEY
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 1:1790 W GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2411
Mailing Address - Country:US
Mailing Address - Phone:601-825-3473
Mailing Address - Fax:601-825-5909
Practice Address - Street 1:1790 W GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2411
Practice Address - Country:US
Practice Address - Phone:601-825-3473
Practice Address - Fax:601-825-5909
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist