Provider Demographics
NPI:1699026559
Name:PAYNE, WENDELL ANTHONY III (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:ANTHONY
Last Name:PAYNE
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 ACACIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4717
Mailing Address - Country:US
Mailing Address - Phone:662-374-1658
Mailing Address - Fax:
Practice Address - Street 1:1770 TC JESTER
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008
Practice Address - Country:US
Practice Address - Phone:713-864-5196
Practice Address - Fax:713-864-5196
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54167183500000X
LA46160183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician