Provider Demographics
NPI:1659425320
Name:PAYNE, WENDI KAYE (RPH)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:KAYE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 BERWICK CIR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8492
Mailing Address - Country:US
Mailing Address - Phone:712-325-4399
Mailing Address - Fax:402-451-8895
Practice Address - Street 1:8401 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2221
Practice Address - Country:US
Practice Address - Phone:402-451-8842
Practice Address - Fax:402-451-8895
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist