Provider Demographics
NPI:1891076154
Name:PAYNE, NATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:PAYNE
Suffix:
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 1:3220 HALIFAX RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-4908
Mailing Address - Country:US
Mailing Address - Phone:434-575-5338
Mailing Address - Fax:434-575-5976
Practice Address - Street 1:318 CRAGHEAD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1416
Practice Address - Country:US
Practice Address - Phone:434-425-0701
Practice Address - Fax:434-575-5976
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19822183500000X
VA0202208484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist