Provider Demographics
NPI:1295128221
Name:PAYNE, JENNIFER (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
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 1:123 FARMGATE RD
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-8265
Mailing Address - Country:US
Mailing Address - Phone:864-346-1333
Mailing Address - Fax:
Practice Address - Street 1:2700 GENTRY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-9412
Practice Address - Country:US
Practice Address - Phone:864-878-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist