Provider Demographics
NPI:1023832672
Name:PAYNE, MCKENZIE SUZANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:SUZANNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BELLAMY AVE
Mailing Address - Street 2:
Mailing Address - City:SURGOINSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37873-2700
Mailing Address - Country:US
Mailing Address - Phone:423-345-0333
Mailing Address - Fax:
Practice Address - Street 1:114 BELLAMY AVE
Practice Address - Street 2:
Practice Address - City:SURGOINSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37873-2700
Practice Address - Country:US
Practice Address - Phone:423-345-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219885183500000X
TN45184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist