Provider Demographics
NPI:1114350089
Name:PAYNE, JOHN ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:PAYNE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 E BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4902
Mailing Address - Country:US
Mailing Address - Phone:910-895-2453
Mailing Address - Fax:910-895-9726
Practice Address - Street 1:1206 E BROAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4902
Practice Address - Country:US
Practice Address - Phone:910-895-2453
Practice Address - Fax:910-895-9726
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist