Provider Demographics
NPI:1750986899
Name:PAYNE, DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
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 1:2641 NIMMO PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-9134
Mailing Address - Country:US
Mailing Address - Phone:757-263-3084
Mailing Address - Fax:757-526-8855
Practice Address - Street 1:300 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3020
Practice Address - Country:US
Practice Address - Phone:757-437-3090
Practice Address - Fax:757-437-3095
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202211202OtherVIRGINIA BOARD OF PHARMACY