Provider Demographics
NPI:1346619392
Name:PAYTON, JAMES E (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:PAYTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HORSESHOE CIR
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-5989
Mailing Address - Country:US
Mailing Address - Phone:208-539-1103
Mailing Address - Fax:
Practice Address - Street 1:77 HORSESHOE CIR
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-5989
Practice Address - Country:US
Practice Address - Phone:208-539-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP3454OtherPHARMACY LICENSE