Basic Information
| Provider Information | |||||||||
| NPI: | 1770256208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | ANGELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10903 NEW HAMPSHIRE AVE BLDG 75 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209031058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404028748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | WHITERIVER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283384911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2021 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PHA2944 | DC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.