Provider Demographics
NPI:1609955376
Name:STANLEY R OR SHERRIE D PAYNE
Entity Type:Organization
Organization Name:STANLEY R OR SHERRIE D PAYNE
Other - Org Name:PAYNE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-983-5111
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLOYDADA
Mailing Address - State:TX
Mailing Address - Zip Code:79235-2726
Mailing Address - Country:US
Mailing Address - Phone:806-983-5111
Mailing Address - Fax:806-983-2819
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FLOYDADA
Practice Address - State:TX
Practice Address - Zip Code:79235-2726
Practice Address - Country:US
Practice Address - Phone:806-983-5111
Practice Address - Fax:806-983-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX157963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144045Medicaid
2102375OtherPK